{ "hospital_name": "Northwestern Medicine Marianjoy Rehabilitation Hospital", "last_updated_on": "2026-04-01", "version": "3.0.0", "location_name": [ "Northwestern Medicine Marianjoy Rehabilitation Hospital" ], "hospital_address": [ "26W171 Roosevelt Road, Wheaton, IL 60187" ], "license_information": { "license_number": "0003228", "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": [ "1083660658" ], "standard_charge_information": [ { "description": "ACETAMINOPHEN 162.5 MG ORAL HALF TAB", "drug_information": { "unit": 162.5, "type": "ME" }, "code_information": [ { "code": "RX-222828", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "99991-0030-13", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.42, "maximum": 1.0, "setting": "outpatient", "gross_charge": 1.0, "discounted_cash": 0.7, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.47, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 0.47, "10th_percentile": 0.47, "90th_percentile": 0.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 0.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 0.67, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.67, "10th_percentile": 0.67, "90th_percentile": 0.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 0.87, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 0.87, "10th_percentile": 0.87, "90th_percentile": 0.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 0.63, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 0.8, "10th_percentile": 0.8, "90th_percentile": 0.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 0.54, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 0.56, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 0.56, "10th_percentile": 0.56, "90th_percentile": 0.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 0.51, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 0.51, "10th_percentile": 0.51, "90th_percentile": 0.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "gross_charge": 50446.5, "discounted_cash": 35312.55, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.731336433; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 50222.5, "10th_percentile": 50222.5, "90th_percentile": 50222.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.731336433; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 50222.5, "10th_percentile": 50222.5, "90th_percentile": 50222.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.731336433; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 50222.5, "10th_percentile": 50222.5, "90th_percentile": 50222.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.731336433; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 50222.5, "10th_percentile": 50222.5, "90th_percentile": 50222.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.731336433; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 50222.5, "10th_percentile": 50222.5, "90th_percentile": 50222.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_percentage": 44.0, "standard_charge_algorithm": "Re-evaluated: HLB.731336433; Using historical claim(s); Scope: All Financial Classes; Cases: 2; Inpatient Services; 44% Billed", "median_amount": 22097.9, "10th_percentile": 22097.9, "90th_percentile": 22097.9, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_percentage": 44.0, "standard_charge_algorithm": "Re-evaluated: HLB.731336433; Using historical claim(s); Scope: All Financial Classes; Cases: 2; Inpatient Services; 44% Billed", "median_amount": 22097.9, "10th_percentile": 22097.9, "90th_percentile": 22097.9, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Re-evaluated: HLB.731336433; Using historical claim(s); Scope: All Financial Classes; Cases: 2; Inpatient Services; 54.35% Billed", "median_amount": 27295.93, "10th_percentile": 27295.93, "90th_percentile": 27295.93, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Re-evaluated: HLB.731336433; Using historical claim(s); Scope: All Financial Classes; Cases: 2; Inpatient Services; 63% Billed", "median_amount": 31640.18, "10th_percentile": 31640.18, "90th_percentile": 31640.18, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_percentage": 49.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, supplies, and therapy services can be included in reimbursement.", "median_amount": 24609.03, "10th_percentile": 24609.03, "90th_percentile": 24609.03, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_percentage": 47.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, supplies, and therapy services can be included in reimbursement.", "median_amount": 23604.58, "10th_percentile": 23604.58, "90th_percentile": 23604.58, "count": "1 through 10", "methodology": "percent of total billed charges" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 23476.01, "maximum": 23476.01, "setting": "inpatient", "gross_charge": 52951.74, "discounted_cash": 37066.22, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_percentage": 44.0, "standard_charge_algorithm": "Re-evaluated: HLB.860735180; Using historical claim(s); Scope: All Financial Classes; Cases: 432; Inpatient Services; 44% Billed", "median_amount": 23298.77, "10th_percentile": 23298.77, "90th_percentile": 23298.77, "count": "432", "methodology": "percent of total billed charges" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_percentage": 44.0, "standard_charge_algorithm": "Re-evaluated: HLB.860735180; Using historical claim(s); Scope: All Financial Classes; Cases: 432; Inpatient Services; 44% Billed", "median_amount": 23298.77, "10th_percentile": 23298.77, "90th_percentile": 23298.77, "count": "432", "methodology": "percent of total billed charges" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Re-evaluated: HLB.860735180; Using historical claim(s); Scope: All Financial Classes; Cases: 432; Inpatient Services; 54.35% Billed", "median_amount": 28779.28, "10th_percentile": 28779.28, "90th_percentile": 28779.28, "count": "432", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Re-evaluated: HLB.860735180; Using historical claim(s); Scope: All Financial Classes; Cases: 432; Inpatient Services; 63% Billed", "median_amount": 33359.6, "10th_percentile": 33359.6, "90th_percentile": 33359.6, "count": "432", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_percentage": 49.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, and therapy services can be included in reimbursement.", "median_amount": 25946.36, "10th_percentile": 25946.36, "90th_percentile": 25946.36, "count": "432", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_percentage": 47.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, and therapy services can be included in reimbursement.", "median_amount": 31408.67, "10th_percentile": 31408.67, "90th_percentile": 31408.67, "count": "432", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.860735180; Using historical claim(s); Scope: All Financial Classes; Cases: 432; All IP Services; 100% Billed", "median_amount": 52951.75, "10th_percentile": 52951.75, "90th_percentile": 52951.75, "count": "432", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.860735180; Using historical claim(s); Scope: All Financial Classes; Cases: 432; All IP Services; 100% Billed", "median_amount": 52951.75, "10th_percentile": 52951.75, "90th_percentile": 52951.75, "count": "432", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.860735180; Using historical claim(s); Scope: All Financial Classes; Cases: 432; All IP Services; 100% Billed", "median_amount": 52951.75, "10th_percentile": 52951.75, "90th_percentile": 52951.75, "count": "432", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.860735180; Using historical claim(s); Scope: All Financial Classes; Cases: 432; All IP Services; 100% Billed", "median_amount": 52951.75, "10th_percentile": 52951.75, "90th_percentile": 52951.75, "count": "432", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.860735180; Using historical claim(s); Scope: All Financial Classes; Cases: 432; All IP Services; 100% Billed", "median_amount": 52951.75, "10th_percentile": 52951.75, "90th_percentile": 52951.75, "count": "432", "methodology": "percent of total billed charges" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_dollar": 23476.01, "standard_charge_algorithm": "Re-evaluated: HLB.860735180; Using historical claim(s); Scope: All Financial Classes; Cases: 432; IP Rehab; FSC: HB MRH & NWR CMG IP REHAB RATES, and; Pricing Extension - HB MRH IP REHAB PPS MEDICARE", "median_amount": 26316.6, "10th_percentile": 26316.6, "90th_percentile": 26316.6, "count": "432", "methodology": "case rate" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_dollar": 23476.01, "standard_charge_algorithm": "Re-evaluated: HLB.860735180; Using historical claim(s); Scope: All Financial Classes; Cases: 432; IP Rehab; FSC: HB MRH & NWR CMG IP REHAB RATES, and; Pricing Extension - HB MRH IP REHAB PPS MEDICARE", "median_amount": 26316.6, "10th_percentile": 26316.6, "90th_percentile": 26316.6, "count": "432", "methodology": "case rate" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_dollar": 23476.01, "standard_charge_algorithm": "Re-evaluated: HLB.860735180; Using historical claim(s); Scope: All Financial Classes; Cases: 432; IP Rehab; FSC: HB MRH & NWR CMG IP REHAB RATES, and; Pricing Extension - HB MRH IP REHAB PPS MEDICARE", "median_amount": 26316.6, "10th_percentile": 26316.6, "90th_percentile": 26316.6, "count": "432", "methodology": "case rate" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 23476.01, "standard_charge_algorithm": "Re-evaluated: HLB.860735180; Using historical claim(s); Scope: All Financial Classes; Cases: 432; IP Rehab; FSC: HB MRH & NWR CMG IP REHAB RATES, and; Pricing Extension - HB MRH IP REHAB PPS MEDICARE", "median_amount": 25759.22, "10th_percentile": 25759.22, "90th_percentile": 25759.22, "count": "432", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 23476.01, "standard_charge_algorithm": "Re-evaluated: HLB.860735180; Using historical claim(s); Scope: All Financial Classes; Cases: 432; IP Rehab; FSC: HB MRH & NWR CMG IP REHAB RATES, and; Pricing Extension - HB MRH IP REHAB PPS MEDICARE", "median_amount": 25759.22, "10th_percentile": 25759.22, "90th_percentile": 25759.22, "count": "432", "methodology": "case rate" } ] } ] }, { "description": "ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INH NEBU|DISCARDED DRUG NOT ADMINISTE", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "RX-250", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0250", "type": "RC" }, { "code": "99991-0042-61", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.05, "maximum": 4.0, "setting": "outpatient", "gross_charge": 2.5, "discounted_cash": 1.75, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.50 @ 12.5% = $0.31 due to $0.00 Claim Price", "median_amount": 0.41, "10th_percentile": 0.33, "90th_percentile": 0.48, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.50 @ 12.5% = $0.31 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.50 @ 12.5% = $0.31 due to $0.00 Claim Price", "median_amount": 0.41, "10th_percentile": 0.33, "90th_percentile": 0.48, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.50 @ 12.5% = $0.31 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.50 @ 12.5% = $0.31 due to $0.00 Claim Price", "median_amount": 0.41, "10th_percentile": 0.33, "90th_percentile": 0.48, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.50 @ 12.5% = $0.31 due to $0.00 Claim Price" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 3.25, "10th_percentile": 2.65, "90th_percentile": 3.85, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.18, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.53, "10th_percentile": 1.25, "90th_percentile": 1.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.05, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.36, "10th_percentile": 1.11, "90th_percentile": 1.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3.25, "10th_percentile": 2.65, "90th_percentile": 3.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1.46, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": 1.55, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 1.54, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 2.0, "10th_percentile": 1.63, "90th_percentile": 2.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 1.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 1.63, "10th_percentile": 1.33, "90th_percentile": 1.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 1.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.95, "10th_percentile": 1.59, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 1.67, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.17, "10th_percentile": 1.77, "90th_percentile": 2.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3.25, "10th_percentile": 2.65, "90th_percentile": 3.85, "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": "MRH HFN", "standard_charge_dollar": 2.18, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 2.83, "10th_percentile": 2.31, "90th_percentile": 3.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 1.58, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.05, "10th_percentile": 1.67, "90th_percentile": 2.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 1.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1.95, "10th_percentile": 1.59, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 1.63, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.12, "10th_percentile": 1.73, "90th_percentile": 2.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3.25, "10th_percentile": 2.65, "90th_percentile": 3.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 1.95, "10th_percentile": 1.59, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.05, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.36, "10th_percentile": 1.11, "90th_percentile": 1.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3.25, "10th_percentile": 2.65, "90th_percentile": 3.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 2.6, "10th_percentile": 2.12, "90th_percentile": 3.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 1.36, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 1.77, "10th_percentile": 1.44, "90th_percentile": 2.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3.25, "10th_percentile": 2.65, "90th_percentile": 3.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.21, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": 1.28, "90th_percentile": 1.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1.36, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 1.77, "10th_percentile": 1.44, "90th_percentile": 2.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.36, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 1.77, "10th_percentile": 1.44, "90th_percentile": 2.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.36, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 1.77, "10th_percentile": 1.44, "90th_percentile": 2.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1.46, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": 1.55, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1.4, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 1.82, "10th_percentile": 1.48, "90th_percentile": 2.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 1.54, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 2.0, "10th_percentile": 1.63, "90th_percentile": 2.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 1.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1.95, "10th_percentile": 1.59, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 1.63, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.12, "10th_percentile": 1.73, "90th_percentile": 2.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 1.63, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 2.12, "10th_percentile": 1.73, "90th_percentile": 2.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 1.95, "10th_percentile": 1.59, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" } ] } ] }, { "description": "ALENDRONATE 70 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-29048", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "65862-0329-04", "type": "NDC" } ], "standard_charges": [ { "minimum": 7.88, "maximum": 18.75, "setting": "outpatient", "gross_charge": 18.75, "discounted_cash": 13.12, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 12.19, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 12.19, "10th_percentile": 12.19, "90th_percentile": 12.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 11.25, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 11.25, "10th_percentile": 11.25, "90th_percentile": 11.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 10.48, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 10.48, "10th_percentile": 10.48, "90th_percentile": 10.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 10.96, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.96, "10th_percentile": 10.96, "90th_percentile": 10.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 10.82, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 10.82, "10th_percentile": 10.82, "90th_percentile": 10.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 12.19, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 12.19, "10th_percentile": 12.19, "90th_percentile": 12.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 9.56, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 9.56, "10th_percentile": 9.56, "90th_percentile": 9.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 11.25, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 9.1, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 9.1, "10th_percentile": 9.1, "90th_percentile": 9.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 9.1, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 9.1, "10th_percentile": 9.1, "90th_percentile": 9.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 8.81, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 8.81, "10th_percentile": 8.81, "90th_percentile": 8.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 10.96, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.96, "10th_percentile": 10.96, "90th_percentile": 10.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 10.82, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 10.82, "10th_percentile": 10.82, "90th_percentile": 10.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 9.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 9.38, "10th_percentile": 9.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 12.54, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.54, "10th_percentile": 12.54, "90th_percentile": 12.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 16.31, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 16.31, "10th_percentile": 16.31, "90th_percentile": 16.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 11.81, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 11.81, "10th_percentile": 11.81, "90th_percentile": 11.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 12.19, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 12.19, "10th_percentile": 12.19, "90th_percentile": 12.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 15.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 15.0, "10th_percentile": 15.0, "90th_percentile": 15.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 10.19, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 10.19, "10th_percentile": 10.19, "90th_percentile": 10.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 9.11, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.11, "10th_percentile": 9.11, "90th_percentile": 9.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 9.09, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.09, "10th_percentile": 9.09, "90th_percentile": 9.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 11.25, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 11.25, "10th_percentile": 11.25, "90th_percentile": 11.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 11.25, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.25, "10th_percentile": 11.25, "90th_percentile": 11.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 11.25, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 7.88, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 7.88, "10th_percentile": 7.88, "90th_percentile": 7.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 7.88, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 7.88, "10th_percentile": 7.88, "90th_percentile": 7.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 18.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18.75, "10th_percentile": 18.75, "90th_percentile": 18.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 18.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18.75, "10th_percentile": 18.75, "90th_percentile": 18.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 18.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18.75, "10th_percentile": 18.75, "90th_percentile": 18.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 18.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18.75, "10th_percentile": 18.75, "90th_percentile": 18.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 18.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18.75, "10th_percentile": 18.75, "90th_percentile": 18.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18.75, "10th_percentile": 18.75, "90th_percentile": 18.75, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18.75, "10th_percentile": 18.75, "90th_percentile": 18.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18.75, "10th_percentile": 18.75, "90th_percentile": 18.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ALLOPURINOL 50 MG ORAL HALF TAB", "drug_information": { "unit": 50.0, "type": "ME" }, "code_information": [ { "code": "RX-4080000002", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00000-0100-02", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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" } ] } ] }, { "description": "ALLOPURINOL 100 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-310", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "51079-0205-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "ALLOPURINOL 100 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-310", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "51079-0205-20", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "ALLOPURINOL 300 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-311", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "00591-5544-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 2.21, "maximum": 5.25, "setting": "outpatient", "gross_charge": 5.25, "discounted_cash": 3.67, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5.25 @ 12.5% = $0.66 due to $0.00 Claim Price", "median_amount": 0.66, "10th_percentile": 0.66, "90th_percentile": 0.66, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5.25 @ 12.5% = $0.66 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5.25 @ 12.5% = $0.66 due to $0.00 Claim Price", "median_amount": 0.66, "10th_percentile": 0.66, "90th_percentile": 0.66, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5.25 @ 12.5% = $0.66 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5.25 @ 12.5% = $0.66 due to $0.00 Claim Price", "median_amount": 0.66, "10th_percentile": 0.66, "90th_percentile": 0.66, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5.25 @ 12.5% = $0.66 due to $0.00 Claim Price" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.86, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2.86, "10th_percentile": 2.86, "90th_percentile": 2.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2.86, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2.86, "10th_percentile": 2.86, "90th_percentile": 2.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2.86, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2.86, "10th_percentile": 2.86, "90th_percentile": 2.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3.07, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.07, "10th_percentile": 3.07, "90th_percentile": 3.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.93, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.93, "10th_percentile": 2.93, "90th_percentile": 2.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3.22, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3.22, "10th_percentile": 3.22, "90th_percentile": 3.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 3.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3.15, "10th_percentile": 3.15, "90th_percentile": 3.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 3.41, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 3.41, "10th_percentile": 3.41, "90th_percentile": 3.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 3.41, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 3.15, "10th_percentile": 3.15, "90th_percentile": 3.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2.47, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2.47, "10th_percentile": 2.47, "90th_percentile": 2.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2.21, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2.21, "10th_percentile": 2.21, "90th_percentile": 2.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3.07, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.07, "10th_percentile": 3.07, "90th_percentile": 3.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 3.22, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3.22, "10th_percentile": 3.22, "90th_percentile": 3.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.63, "10th_percentile": 2.63, "90th_percentile": 2.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 3.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.15, "10th_percentile": 3.15, "90th_percentile": 3.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 3.51, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.51, "10th_percentile": 3.51, "90th_percentile": 3.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 4.57, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 4.57, "10th_percentile": 4.57, "90th_percentile": 4.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 3.31, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 3.31, "10th_percentile": 3.31, "90th_percentile": 3.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 3.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3.15, "10th_percentile": 3.15, "90th_percentile": 3.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 3.41, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 3.41, "10th_percentile": 3.41, "90th_percentile": 3.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 3.15, "10th_percentile": 3.15, "90th_percentile": 3.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2.21, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2.21, "10th_percentile": 2.21, "90th_percentile": 2.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 4.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.85, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.85, "10th_percentile": 2.85, "90th_percentile": 2.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 2.55, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.55, "10th_percentile": 2.55, "90th_percentile": 2.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": 129.05, "maximum": 307.25, "setting": "outpatient", "gross_charge": 307.25, "discounted_cash": 215.07, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 149.11, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 149.11, "10th_percentile": 149.11, "90th_percentile": 149.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 149.11, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 149.11, "10th_percentile": 149.11, "90th_percentile": 149.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 184.35, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 184.35, "10th_percentile": 184.35, "90th_percentile": 184.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 171.75, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 171.75, "10th_percentile": 171.75, "90th_percentile": 171.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 179.56, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 179.56, "10th_percentile": 179.56, "90th_percentile": 179.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 177.22, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 177.22, "10th_percentile": 177.22, "90th_percentile": 177.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 156.57, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 156.57, "10th_percentile": 156.57, "90th_percentile": 156.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 199.71, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 199.71, "10th_percentile": 199.71, "90th_percentile": 199.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 184.35, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 184.35, "10th_percentile": 184.35, "90th_percentile": 184.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 199.71, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 199.71, "10th_percentile": 199.71, "90th_percentile": 199.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 153.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 153.63, "10th_percentile": 153.63, "90th_percentile": 153.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH UHC CORE", "standard_charge_dollar": 149.02, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 149.02, "10th_percentile": 149.02, "90th_percentile": 149.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 193.57, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 193.57, "10th_percentile": 193.57, "90th_percentile": 193.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 144.41, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 144.41, "10th_percentile": 144.41, "90th_percentile": 144.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 179.56, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 179.56, "10th_percentile": 179.56, "90th_percentile": 179.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 177.22, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 177.22, "10th_percentile": 177.22, "90th_percentile": 177.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 267.31, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 267.31, "10th_percentile": 267.31, "90th_percentile": 267.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 205.55, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 205.55, "10th_percentile": 205.55, "90th_percentile": 205.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 199.71, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 199.71, "10th_percentile": 199.71, "90th_percentile": 199.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 166.99, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 166.99, "10th_percentile": 166.99, "90th_percentile": 166.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 245.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 245.8, "10th_percentile": 245.8, "90th_percentile": 245.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 149.32, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 149.32, "10th_percentile": 149.32, "90th_percentile": 149.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 184.35, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 184.35, "10th_percentile": 184.35, "90th_percentile": 184.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 184.35, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 184.35, "10th_percentile": 184.35, "90th_percentile": 184.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 184.35, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 184.35, "10th_percentile": 184.35, "90th_percentile": 184.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 129.05, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 129.05, "10th_percentile": 129.05, "90th_percentile": 129.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 129.05, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 129.05, "10th_percentile": 129.05, "90th_percentile": 129.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 307.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 307.25, "10th_percentile": 307.25, "90th_percentile": 307.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 307.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 307.25, "10th_percentile": 307.25, "90th_percentile": 307.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 307.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 307.25, "10th_percentile": 307.25, "90th_percentile": 307.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 307.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 307.25, "10th_percentile": 307.25, "90th_percentile": 307.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 307.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 307.25, "10th_percentile": 307.25, "90th_percentile": 307.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 307.25, "10th_percentile": 307.25, "90th_percentile": 307.25, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 307.25, "10th_percentile": 307.25, "90th_percentile": 307.25, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 307.25, "10th_percentile": 307.25, "90th_percentile": 307.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AMIODARONE 200 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-9066", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "68084-0371-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "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": 9.24, "maximum": 22.0, "setting": "outpatient", "gross_charge": 22.0, "discounted_cash": 15.4, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $22.00 @ 12.5% = $2.75 due to $0.00 Claim Price", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 2.75, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $22.00 @ 12.5% = $2.75 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $22.00 @ 12.5% = $2.75 due to $0.00 Claim Price", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 2.75, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $22.00 @ 12.5% = $2.75 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $22.00 @ 12.5% = $2.75 due to $0.00 Claim Price", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 2.75, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $22.00 @ 12.5% = $2.75 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 12.36, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 12.36, "10th_percentile": 12.36, "90th_percentile": 12.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH AETNA", "standard_charge_dollar": 12.36, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 12.36, "10th_percentile": 12.36, "90th_percentile": 12.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 13.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 13.2, "10th_percentile": 13.2, "90th_percentile": 13.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 13.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 13.2, "10th_percentile": 13.2, "90th_percentile": 13.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 13.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 13.2, "90th_percentile": 13.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 14.72, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 14.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 10.67, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.67, "10th_percentile": 10.67, "90th_percentile": 10.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS HMO", "standard_charge_dollar": 12.86, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.86, "10th_percentile": 12.86, "90th_percentile": 12.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 10.69, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH PHCS", "standard_charge_dollar": 17.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 11.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 13.86, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 13.86, "10th_percentile": 13.86, "90th_percentile": 13.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 11.96, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 11.96, "10th_percentile": 11.96, "90th_percentile": 11.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 19.14, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 19.14, "10th_percentile": 19.14, "90th_percentile": 19.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 14.3, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 14.3, "10th_percentile": 14.3, "90th_percentile": 14.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 10.34, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 10.34, "10th_percentile": 10.34, "90th_percentile": 10.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 13.51, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 13.51, "10th_percentile": 13.51, "90th_percentile": 13.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 9.24, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 9.24, "10th_percentile": 9.24, "90th_percentile": 9.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 9.24, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 9.24, "10th_percentile": 9.24, "90th_percentile": 9.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 11.99, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 11.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 11.99, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 11.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 11.99, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 11.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 12.3, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 12.3, "10th_percentile": 12.3, "90th_percentile": 12.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 12.86, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.86, "10th_percentile": 12.86, "90th_percentile": 12.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 14.3, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 14.3, "10th_percentile": 14.3, "90th_percentile": 14.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 13.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 13.2, "10th_percentile": 13.2, "90th_percentile": 13.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 13.51, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 13.51, "10th_percentile": 13.51, "90th_percentile": 13.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 13.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 13.2, "10th_percentile": 13.2, "90th_percentile": 13.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 14.3, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 14.3, "10th_percentile": 14.3, "90th_percentile": 14.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" } ] } ] }, { "description": "AMLODIPINE 1.25 MG ORAL TAB", "drug_information": { "unit": 1.25, "type": "ME" }, "code_information": [ { "code": "RX-4080000210", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "99991-0024-22", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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" } ] } ] }, { "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": "00781-1831-20", "type": "NDC" } ], "standard_charges": [ { "minimum": 2.1, "maximum": 5.0, "setting": "outpatient", "gross_charge": 5.0, "discounted_cash": 3.5, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 3.25, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.8, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.8, "10th_percentile": 2.8, "90th_percentile": 2.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.92, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.92, "10th_percentile": 2.92, "90th_percentile": 2.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.88, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.88, "10th_percentile": 2.88, "90th_percentile": 2.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 3.25, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 3.25, "10th_percentile": 3.25, "90th_percentile": 3.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.55, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% 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; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 3.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2.43, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% 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; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2.43, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% 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; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2.35, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2.35, "10th_percentile": 2.35, "90th_percentile": 2.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.92, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.92, "10th_percentile": 2.92, "90th_percentile": 2.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 2.88, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.88, "10th_percentile": 2.88, "90th_percentile": 2.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.5, "10th_percentile": 2.5, "90th_percentile": 2.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 3.35, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.35, "10th_percentile": 3.35, "90th_percentile": 3.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 4.35, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 4.35, "10th_percentile": 4.35, "90th_percentile": 4.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 3.15, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 3.15, "10th_percentile": 3.15, "90th_percentile": 3.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 3.25, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 3.25, "10th_percentile": 3.25, "90th_percentile": 3.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 4.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% 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 Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.72, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.72, "10th_percentile": 2.72, "90th_percentile": 2.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 2.43, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.43, "10th_percentile": 2.43, "90th_percentile": 2.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 2.43, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.43, "10th_percentile": 2.43, "90th_percentile": 2.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 3.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.0, "10th_percentile": 3.0, "90th_percentile": 3.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 3.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2.1, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2.1, "10th_percentile": 2.1, "90th_percentile": 2.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2.1, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2.1, "10th_percentile": 2.1, "90th_percentile": 2.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.0, "10th_percentile": 5.0, "90th_percentile": 5.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.0, "10th_percentile": 5.0, "90th_percentile": 5.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.0, "10th_percentile": 5.0, "90th_percentile": 5.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.0, "10th_percentile": 5.0, "90th_percentile": 5.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.0, "10th_percentile": 5.0, "90th_percentile": 5.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.0, "10th_percentile": 5.0, "90th_percentile": 5.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.0, "10th_percentile": 5.0, "90th_percentile": 5.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.0, "10th_percentile": 5.0, "90th_percentile": 5.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-33227", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "65862-0502-20", "type": "NDC" } ], "standard_charges": [ { "minimum": 2.21, "maximum": 5.25, "setting": "outpatient", "gross_charge": 5.25, "discounted_cash": 3.67, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 3.41, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 3.15, "10th_percentile": 3.15, "90th_percentile": 3.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.93, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.93, "10th_percentile": 2.93, "90th_percentile": 2.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3.07, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.07, "10th_percentile": 3.07, "90th_percentile": 3.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3.03, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 3.03, "10th_percentile": 3.03, "90th_percentile": 3.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 3.41, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 3.41, "10th_percentile": 3.41, "90th_percentile": 3.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.68, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 3.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3.15, "10th_percentile": 3.15, "90th_percentile": 3.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2.55, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% 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; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2.55, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% 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; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2.47, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2.47, "10th_percentile": 2.47, "90th_percentile": 2.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3.07, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.07, "10th_percentile": 3.07, "90th_percentile": 3.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 3.03, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 3.03, "10th_percentile": 3.03, "90th_percentile": 3.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.63, "10th_percentile": 2.63, "90th_percentile": 2.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 3.51, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.51, "10th_percentile": 3.51, "90th_percentile": 3.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 4.57, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 4.57, "10th_percentile": 4.57, "90th_percentile": 4.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 3.31, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 3.31, "10th_percentile": 3.31, "90th_percentile": 3.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 3.41, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 3.41, "10th_percentile": 3.41, "90th_percentile": 3.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 4.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.85, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.85, "10th_percentile": 2.85, "90th_percentile": 2.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 2.55, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.55, "10th_percentile": 2.55, "90th_percentile": 2.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 2.55, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.55, "10th_percentile": 2.55, "90th_percentile": 2.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 3.15, "10th_percentile": 3.15, "90th_percentile": 3.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 3.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.15, "10th_percentile": 3.15, "90th_percentile": 3.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 3.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3.15, "10th_percentile": 3.15, "90th_percentile": 3.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2.21, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2.21, "10th_percentile": 2.21, "90th_percentile": 2.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2.21, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2.21, "10th_percentile": 2.21, "90th_percentile": 2.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "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": 54.92, "maximum": 130.75, "setting": "outpatient", "gross_charge": 130.75, "discounted_cash": 91.52, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 63.45, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 63.45, "10th_percentile": 63.45, "90th_percentile": 63.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 63.45, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 63.45, "10th_percentile": 63.45, "90th_percentile": 63.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 78.45, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 78.45, "10th_percentile": 78.45, "90th_percentile": 78.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 73.09, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 73.09, "10th_percentile": 73.09, "90th_percentile": 73.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 76.41, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 76.41, "10th_percentile": 76.41, "90th_percentile": 76.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 75.42, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 75.42, "10th_percentile": 75.42, "90th_percentile": 75.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 66.63, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 66.63, "10th_percentile": 66.63, "90th_percentile": 66.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 84.99, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 84.99, "10th_percentile": 84.99, "90th_percentile": 84.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 78.45, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 78.45, "10th_percentile": 78.45, "90th_percentile": 78.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 84.99, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 84.99, "10th_percentile": 84.99, "90th_percentile": 84.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 65.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 65.38, "10th_percentile": 65.38, "90th_percentile": 65.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH UHC CORE", "standard_charge_dollar": 63.41, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 63.41, "10th_percentile": 63.41, "90th_percentile": 63.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 82.37, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 82.37, "10th_percentile": 82.37, "90th_percentile": 82.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 61.45, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 61.45, "10th_percentile": 61.45, "90th_percentile": 61.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 76.41, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 76.41, "10th_percentile": 76.41, "90th_percentile": 76.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 75.42, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 75.42, "10th_percentile": 75.42, "90th_percentile": 75.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 113.75, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 113.75, "10th_percentile": 113.75, "90th_percentile": 113.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 87.47, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 87.47, "10th_percentile": 87.47, "90th_percentile": 87.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 84.99, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 84.99, "10th_percentile": 84.99, "90th_percentile": 84.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 71.06, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 71.06, "10th_percentile": 71.06, "90th_percentile": 71.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 104.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 104.6, "10th_percentile": 104.6, "90th_percentile": 104.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 63.54, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 63.54, "10th_percentile": 63.54, "90th_percentile": 63.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 78.45, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 78.45, "10th_percentile": 78.45, "90th_percentile": 78.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 78.45, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 78.45, "10th_percentile": 78.45, "90th_percentile": 78.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 78.45, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 78.45, "10th_percentile": 78.45, "90th_percentile": 78.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 54.92, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 54.92, "10th_percentile": 54.92, "90th_percentile": 54.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 54.92, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 54.92, "10th_percentile": 54.92, "90th_percentile": 54.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 130.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 130.75, "10th_percentile": 130.75, "90th_percentile": 130.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 130.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 130.75, "10th_percentile": 130.75, "90th_percentile": 130.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 130.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 130.75, "10th_percentile": 130.75, "90th_percentile": 130.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 130.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 130.75, "10th_percentile": 130.75, "90th_percentile": 130.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 130.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 130.75, "10th_percentile": 130.75, "90th_percentile": 130.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 130.75, "10th_percentile": 130.75, "90th_percentile": 130.75, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 130.75, "10th_percentile": 130.75, "90th_percentile": 130.75, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 130.75, "10th_percentile": 130.75, "90th_percentile": 130.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ARIPIPRAZOLE 2 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-70306", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "43598-0554-30", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.79, "maximum": 4.25, "setting": "outpatient", "gross_charge": 4.25, "discounted_cash": 2.97, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.76, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 2.76, "10th_percentile": 2.76, "90th_percentile": 2.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 2.55, "10th_percentile": 2.55, "90th_percentile": 2.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.38, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.38, "10th_percentile": 2.38, "90th_percentile": 2.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.48, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.45, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.45, "10th_percentile": 2.45, "90th_percentile": 2.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.76, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.76, "10th_percentile": 2.76, "90th_percentile": 2.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.17, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 2.55, "10th_percentile": 2.55, "90th_percentile": 2.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2.06, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 2.06, "10th_percentile": 2.06, "90th_percentile": 2.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2.06, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 2.06, "10th_percentile": 2.06, "90th_percentile": 2.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2.0, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% 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 Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.48, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 2.45, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.45, "10th_percentile": 2.45, "90th_percentile": 2.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.13, "10th_percentile": 2.13, "90th_percentile": 2.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.84, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.84, "10th_percentile": 2.84, "90th_percentile": 2.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.7, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.7, "10th_percentile": 3.7, "90th_percentile": 3.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.68, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.76, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.76, "10th_percentile": 2.76, "90th_percentile": 2.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 3.4, "10th_percentile": 3.4, "90th_percentile": 3.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.31, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 2.07, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.07, "10th_percentile": 2.07, "90th_percentile": 2.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 2.06, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.06, "10th_percentile": 2.06, "90th_percentile": 2.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 2.55, "10th_percentile": 2.55, "90th_percentile": 2.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.55, "10th_percentile": 2.55, "90th_percentile": 2.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 2.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 2.55, "10th_percentile": 2.55, "90th_percentile": 2.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.79, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.79, "10th_percentile": 1.79, "90th_percentile": 1.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.79, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.79, "10th_percentile": 1.79, "90th_percentile": 1.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4.25, "10th_percentile": 4.25, "90th_percentile": 4.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4.25, "10th_percentile": 4.25, "90th_percentile": 4.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4.25, "10th_percentile": 4.25, "90th_percentile": 4.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4.25, "10th_percentile": 4.25, "90th_percentile": 4.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4.25, "10th_percentile": 4.25, "90th_percentile": 4.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4.25, "10th_percentile": 4.25, "90th_percentile": 4.25, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4.25, "10th_percentile": 4.25, "90th_percentile": 4.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4.25, "10th_percentile": 4.25, "90th_percentile": 4.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ARIPIPRAZOLE 5 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-36438", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "16729-0279-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "ARIPIPRAZOLE 5 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-36438", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "60505-2673-03", "type": "NDC" } ], "standard_charges": [ { "minimum": 8.51, "maximum": 20.25, "setting": "outpatient", "gross_charge": 20.25, "discounted_cash": 14.17, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 13.16, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 13.16, "10th_percentile": 13.16, "90th_percentile": 13.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 12.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 12.15, "10th_percentile": 12.15, "90th_percentile": 12.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 11.32, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 11.32, "10th_percentile": 11.32, "90th_percentile": 11.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 11.83, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.83, "10th_percentile": 11.83, "90th_percentile": 11.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 11.68, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 11.68, "10th_percentile": 11.68, "90th_percentile": 11.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 13.16, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 13.16, "10th_percentile": 13.16, "90th_percentile": 13.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 10.32, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 10.32, "10th_percentile": 10.32, "90th_percentile": 10.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 12.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 12.15, "10th_percentile": 12.15, "90th_percentile": 12.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 9.83, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 9.83, "10th_percentile": 9.83, "90th_percentile": 9.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 9.83, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 9.83, "10th_percentile": 9.83, "90th_percentile": 9.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 9.52, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 9.52, "10th_percentile": 9.52, "90th_percentile": 9.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 11.83, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.83, "10th_percentile": 11.83, "90th_percentile": 11.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 11.68, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 11.68, "10th_percentile": 11.68, "90th_percentile": 11.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 10.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 10.13, "10th_percentile": 10.13, "90th_percentile": 10.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 13.55, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.55, "10th_percentile": 13.55, "90th_percentile": 13.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 17.62, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 17.62, "10th_percentile": 17.62, "90th_percentile": 17.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 12.76, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 12.76, "10th_percentile": 12.76, "90th_percentile": 12.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 13.16, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 13.16, "10th_percentile": 13.16, "90th_percentile": 13.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 16.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 16.2, "10th_percentile": 16.2, "90th_percentile": 16.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 11.01, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 11.01, "10th_percentile": 11.01, "90th_percentile": 11.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 9.84, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.84, "10th_percentile": 9.84, "90th_percentile": 9.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 9.82, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.82, "10th_percentile": 9.82, "90th_percentile": 9.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 12.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 12.15, "10th_percentile": 12.15, "90th_percentile": 12.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 12.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.15, "10th_percentile": 12.15, "90th_percentile": 12.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 12.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 12.15, "10th_percentile": 12.15, "90th_percentile": 12.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 8.51, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 8.51, "10th_percentile": 8.51, "90th_percentile": 8.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 8.51, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 8.51, "10th_percentile": 8.51, "90th_percentile": 8.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ARIPIPRAZOLE 10 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-34369", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "62332-0099-30", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "ASCORBIC ACID (VITAMIN C) 250 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-663", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "50268-0860-15", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.53, "maximum": 1.25, "setting": "outpatient", "gross_charge": 1.25, "discounted_cash": 0.87, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 0.81, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 0.81, "10th_percentile": 0.81, "90th_percentile": 0.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.75, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.75, "10th_percentile": 0.75, "90th_percentile": 0.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 0.7, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 0.7, "10th_percentile": 0.7, "90th_percentile": 0.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 0.73, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.73, "10th_percentile": 0.73, "90th_percentile": 0.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 0.72, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% 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; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.81, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.81, "10th_percentile": 0.81, "90th_percentile": 0.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 0.64, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 0.64, "10th_percentile": 0.64, "90th_percentile": 0.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 0.75, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.75, "10th_percentile": 0.75, "90th_percentile": 0.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 0.61, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.61, "10th_percentile": 0.61, "90th_percentile": 0.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 0.61, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.61, "10th_percentile": 0.61, "90th_percentile": 0.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.59, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 0.59, "10th_percentile": 0.59, "90th_percentile": 0.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 0.73, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.73, "10th_percentile": 0.73, "90th_percentile": 0.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 0.72, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% 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; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 0.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 0.84, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 1.09, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 1.09, "10th_percentile": 1.09, "90th_percentile": 1.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 0.79, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 0.79, "10th_percentile": 0.79, "90th_percentile": 0.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.81, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.81, "10th_percentile": 0.81, "90th_percentile": 0.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 0.68, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 0.68, "10th_percentile": 0.68, "90th_percentile": 0.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 0.61, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.61, "10th_percentile": 0.61, "90th_percentile": 0.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 0.61, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.61, "10th_percentile": 0.61, "90th_percentile": 0.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.75, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.75, "10th_percentile": 0.75, "90th_percentile": 0.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 0.75, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.75, "10th_percentile": 0.75, "90th_percentile": 0.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 0.75, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.75, "10th_percentile": 0.75, "90th_percentile": 0.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.53, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.53, "10th_percentile": 0.53, "90th_percentile": 0.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.53, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.53, "10th_percentile": 0.53, "90th_percentile": 0.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.25, "10th_percentile": 1.25, "90th_percentile": 1.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.25, "10th_percentile": 1.25, "90th_percentile": 1.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.25, "10th_percentile": 1.25, "90th_percentile": 1.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.25, "10th_percentile": 1.25, "90th_percentile": 1.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.25, "10th_percentile": 1.25, "90th_percentile": 1.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.25, "10th_percentile": 1.25, "90th_percentile": 1.25, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.25, "10th_percentile": 1.25, "90th_percentile": 1.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.25, "10th_percentile": 1.25, "90th_percentile": 1.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ASPIRIN 81 MG ORAL TBEC", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-14113", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00904-6783-70", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.42, "maximum": 1.0, "setting": "outpatient", "gross_charge": 1.0, "discounted_cash": 0.7, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 0.56, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 0.56, "10th_percentile": 0.56, "90th_percentile": 0.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 0.51, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 0.51, "10th_percentile": 0.51, "90th_percentile": 0.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 0.54, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 0.8, "10th_percentile": 0.8, "90th_percentile": 0.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 0.63, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 0.87, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 0.87, "10th_percentile": 0.87, "90th_percentile": 0.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 0.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.47, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 0.47, "10th_percentile": 0.47, "90th_percentile": 0.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 0.67, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.67, "10th_percentile": 0.67, "90th_percentile": 0.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ASPIRIN 325 MG ORAL TBEC", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-13654", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "69618-0015-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.42, "maximum": 1.0, "setting": "outpatient", "gross_charge": 1.0, "discounted_cash": 0.7, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 0.56, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 0.56, "10th_percentile": 0.56, "90th_percentile": 0.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 0.51, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 0.51, "10th_percentile": 0.51, "90th_percentile": 0.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 0.54, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 0.8, "10th_percentile": 0.8, "90th_percentile": 0.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 0.63, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 0.87, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 0.87, "10th_percentile": 0.87, "90th_percentile": 0.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 0.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.47, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 0.47, "10th_percentile": 0.47, "90th_percentile": 0.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 0.67, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.67, "10th_percentile": 0.67, "90th_percentile": 0.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "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": "51079-0759-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 4.0, "10th_percentile": 4.0, "90th_percentile": 4.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4.00 @ 12.5% = $0.50 due to $0.00 Claim Price", "median_amount": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4.00 @ 12.5% = $0.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4.00 @ 12.5% = $0.50 due to $0.00 Claim Price", "median_amount": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4.00 @ 12.5% = $0.50 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4.00 @ 12.5% = $0.50 due to $0.00 Claim Price", "median_amount": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4.00 @ 12.5% = $0.50 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.18, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2.18, "10th_percentile": 2.18, "90th_percentile": 2.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2.18, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2.18, "10th_percentile": 2.18, "90th_percentile": 2.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2.18, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2.18, "10th_percentile": 2.18, "90th_percentile": 2.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.46, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 2.46, "10th_percentile": 2.46, "90th_percentile": 2.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.46, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 2.46, "10th_percentile": 2.46, "90th_percentile": 2.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "ATORVASTATIN 10 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-19176", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "60505-2578-09", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "ATORVASTATIN 40 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-19177", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "68084-0099-11", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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" } ] } ] }, { "description": "ATORVASTATIN 80 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-28645", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00904-6293-04", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "AZITHROMYCIN 250 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-20943", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "50268-0074-11", "type": "NDC" } ], "standard_charges": [ { "minimum": 2.94, "maximum": 7.0, "setting": "outpatient", "gross_charge": 7.0, "discounted_cash": 4.9, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7.00 @ 12.5% = $0.88 due to $0.00 Claim Price", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 0.88, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7.00 @ 12.5% = $0.88 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7.00 @ 12.5% = $0.88 due to $0.00 Claim Price", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 0.88, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7.00 @ 12.5% = $0.88 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7.00 @ 12.5% = $0.88 due to $0.00 Claim Price", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 0.88, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7.00 @ 12.5% = $0.88 due to $0.00 Claim Price" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3.82, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3.82, "10th_percentile": 3.82, "90th_percentile": 3.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 3.82, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3.82, "10th_percentile": 3.82, "90th_percentile": 3.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 3.82, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3.82, "10th_percentile": 3.82, "90th_percentile": 3.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 4.09, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.09, "10th_percentile": 4.09, "90th_percentile": 4.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3.91, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 3.91, "10th_percentile": 3.91, "90th_percentile": 3.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 4.3, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 4.3, "10th_percentile": 4.3, "90th_percentile": 4.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 4.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 4.55, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 4.55, "10th_percentile": 4.55, "90th_percentile": 4.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 4.55, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 4.55, "10th_percentile": 4.55, "90th_percentile": 4.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 4.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 3.29, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 3.29, "10th_percentile": 3.29, "90th_percentile": 3.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2.94, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2.94, "10th_percentile": 2.94, "90th_percentile": 2.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 4.09, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.09, "10th_percentile": 4.09, "90th_percentile": 4.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 4.3, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 4.3, "10th_percentile": 4.3, "90th_percentile": 4.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 3.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 3.5, "10th_percentile": 3.5, "90th_percentile": 3.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 4.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 4.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.68, "10th_percentile": 4.68, "90th_percentile": 4.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "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": "MRH HFN", "standard_charge_dollar": 6.09, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 6.09, "10th_percentile": 6.09, "90th_percentile": 6.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 4.41, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 4.41, "10th_percentile": 4.41, "90th_percentile": 4.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 4.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 4.55, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 4.55, "10th_percentile": 4.55, "90th_percentile": 4.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 4.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2.94, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2.94, "10th_percentile": 2.94, "90th_percentile": 2.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 5.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 5.6, "10th_percentile": 5.6, "90th_percentile": 5.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 3.8, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 3.8, "10th_percentile": 3.8, "90th_percentile": 3.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 3.4, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.4, "10th_percentile": 3.4, "90th_percentile": 3.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "AZITHROMYCIN 250 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-20943", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "65862-0641-30", "type": "NDC" } ], "standard_charges": [ { "minimum": 4.94, "maximum": 11.75, "setting": "outpatient", "gross_charge": 11.75, "discounted_cash": 8.22, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11.75 @ 12.5% = $1.47 due to $0.00 Claim Price", "median_amount": 1.47, "10th_percentile": 1.47, "90th_percentile": 1.47, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11.75 @ 12.5% = $1.47 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11.75 @ 12.5% = $1.47 due to $0.00 Claim Price", "median_amount": 1.47, "10th_percentile": 1.47, "90th_percentile": 1.47, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11.75 @ 12.5% = $1.47 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11.75 @ 12.5% = $1.47 due to $0.00 Claim Price", "median_amount": 1.47, "10th_percentile": 1.47, "90th_percentile": 1.47, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11.75 @ 12.5% = $1.47 due to $0.00 Claim Price" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 11.75, "10th_percentile": 11.75, "90th_percentile": 11.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 5.52, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 5.52, "10th_percentile": 5.52, "90th_percentile": 5.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 4.94, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 4.94, "10th_percentile": 4.94, "90th_percentile": 4.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 11.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.75, "10th_percentile": 11.75, "90th_percentile": 11.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 6.87, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.87, "10th_percentile": 6.87, "90th_percentile": 6.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 7.21, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 7.21, "10th_percentile": 7.21, "90th_percentile": 7.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 5.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 5.88, "10th_percentile": 5.88, "90th_percentile": 5.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 7.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.05, "10th_percentile": 7.05, "90th_percentile": 7.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 7.86, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.86, "10th_percentile": 7.86, "90th_percentile": 7.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 11.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.75, "10th_percentile": 11.75, "90th_percentile": 11.75, "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": "MRH HFN", "standard_charge_dollar": 10.22, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 10.22, "10th_percentile": 10.22, "90th_percentile": 10.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 7.4, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 7.4, "10th_percentile": 7.4, "90th_percentile": 7.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 7.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 7.05, "10th_percentile": 7.05, "90th_percentile": 7.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 7.64, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 7.64, "10th_percentile": 7.64, "90th_percentile": 7.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 11.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.75, "10th_percentile": 11.75, "90th_percentile": 11.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 7.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 7.05, "10th_percentile": 7.05, "90th_percentile": 7.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 4.94, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 4.94, "10th_percentile": 4.94, "90th_percentile": 4.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 11.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.75, "10th_percentile": 11.75, "90th_percentile": 11.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 9.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 9.4, "10th_percentile": 9.4, "90th_percentile": 9.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 6.39, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 6.39, "10th_percentile": 6.39, "90th_percentile": 6.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 11.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.75, "10th_percentile": 11.75, "90th_percentile": 11.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 5.7, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.7, "10th_percentile": 5.7, "90th_percentile": 5.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 6.4, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 6.4, "10th_percentile": 6.4, "90th_percentile": 6.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 6.4, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 6.4, "10th_percentile": 6.4, "90th_percentile": 6.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 6.4, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 6.4, "10th_percentile": 6.4, "90th_percentile": 6.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 6.87, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.87, "10th_percentile": 6.87, "90th_percentile": 6.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 6.57, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 6.57, "10th_percentile": 6.57, "90th_percentile": 6.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 7.21, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 7.21, "10th_percentile": 7.21, "90th_percentile": 7.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 7.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 7.05, "10th_percentile": 7.05, "90th_percentile": 7.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 7.64, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 7.64, "10th_percentile": 7.64, "90th_percentile": 7.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 7.64, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 7.64, "10th_percentile": 7.64, "90th_percentile": 7.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 7.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 7.05, "10th_percentile": 7.05, "90th_percentile": 7.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" } ] } ] }, { "description": "BACLOFEN 5 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-218821", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "52817-0319-10", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "BACLOFEN 10 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-860", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "63739-0479-10", "type": "NDC" } ], "standard_charges": [ { "minimum": 2.73, "maximum": 6.5, "setting": "outpatient", "gross_charge": 6.5, "discounted_cash": 4.55, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.50 @ 12.5% = $0.81 due to $0.00 Claim Price", "median_amount": 0.81, "10th_percentile": 0.81, "90th_percentile": 0.81, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.50 @ 12.5% = $0.81 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.50 @ 12.5% = $0.81 due to $0.00 Claim Price", "median_amount": 0.81, "10th_percentile": 0.81, "90th_percentile": 0.81, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.50 @ 12.5% = $0.81 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.50 @ 12.5% = $0.81 due to $0.00 Claim Price", "median_amount": 0.81, "10th_percentile": 0.81, "90th_percentile": 0.81, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.50 @ 12.5% = $0.81 due to $0.00 Claim Price" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 3.06, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 3.06, "10th_percentile": 3.06, "90th_percentile": 3.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2.73, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2.73, "10th_percentile": 2.73, "90th_percentile": 2.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3.8, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.8, "10th_percentile": 3.8, "90th_percentile": 3.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 3.99, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3.99, "10th_percentile": 3.99, "90th_percentile": 3.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 3.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 3.25, "10th_percentile": 3.25, "90th_percentile": 3.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 3.9, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.9, "10th_percentile": 3.9, "90th_percentile": 3.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 4.35, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 5.66, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 5.66, "10th_percentile": 5.66, "90th_percentile": 5.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 4.1, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 4.1, "10th_percentile": 4.1, "90th_percentile": 4.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 3.9, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3.9, "10th_percentile": 3.9, "90th_percentile": 3.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 4.23, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 4.23, "10th_percentile": 4.23, "90th_percentile": 4.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3.9, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 3.9, "10th_percentile": 3.9, "90th_percentile": 3.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2.73, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2.73, "10th_percentile": 2.73, "90th_percentile": 2.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 5.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 5.2, "10th_percentile": 5.2, "90th_percentile": 5.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 3.53, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 3.53, "10th_percentile": 3.53, "90th_percentile": 3.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 3.15, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.15, "10th_percentile": 3.15, "90th_percentile": 3.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3.54, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3.54, "10th_percentile": 3.54, "90th_percentile": 3.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 3.54, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3.54, "10th_percentile": 3.54, "90th_percentile": 3.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 3.54, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3.54, "10th_percentile": 3.54, "90th_percentile": 3.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3.8, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.8, "10th_percentile": 3.8, "90th_percentile": 3.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3.63, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 3.63, "10th_percentile": 3.63, "90th_percentile": 3.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3.99, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3.99, "10th_percentile": 3.99, "90th_percentile": 3.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 3.9, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3.9, "10th_percentile": 3.9, "90th_percentile": 3.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 4.23, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 4.23, "10th_percentile": 4.23, "90th_percentile": 4.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 4.23, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 4.23, "10th_percentile": 4.23, "90th_percentile": 4.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3.9, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 3.9, "10th_percentile": 3.9, "90th_percentile": 3.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" } ] } ] }, { "description": "BALSALAZIDE 750 MG ORAL CAP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-29299", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "60505-2575-07", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "BETAMETHASONE DIPROPIONATE 0.05 % TOP CREA", "drug_information": { "unit": 15.0, "type": "GR" }, "code_information": [ { "code": "RX-1027", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00472-0380-15", "type": "NDC" } ], "standard_charges": [ { "minimum": 90.41, "maximum": 215.25, "setting": "outpatient", "gross_charge": 215.25, "discounted_cash": 150.67, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 90.41, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 90.41, "10th_percentile": 90.41, "90th_percentile": 90.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 90.41, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 90.41, "10th_percentile": 90.41, "90th_percentile": 90.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 101.17, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 101.17, "10th_percentile": 101.17, "90th_percentile": 101.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 125.79, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 125.79, "10th_percentile": 125.79, "90th_percentile": 125.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 124.16, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 124.16, "10th_percentile": 124.16, "90th_percentile": 124.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 107.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 107.63, "10th_percentile": 107.63, "90th_percentile": 107.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 129.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 129.15, "10th_percentile": 129.15, "90th_percentile": 129.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 144.0, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 144.0, "10th_percentile": 144.0, "90th_percentile": 144.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 187.27, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 187.27, "10th_percentile": 187.27, "90th_percentile": 187.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 135.61, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 135.61, "10th_percentile": 135.61, "90th_percentile": 135.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 129.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 129.15, "10th_percentile": 129.15, "90th_percentile": 129.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 139.91, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 139.91, "10th_percentile": 139.91, "90th_percentile": 139.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 129.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 129.15, "10th_percentile": 129.15, "90th_percentile": 129.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 172.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 172.2, "10th_percentile": 172.2, "90th_percentile": 172.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 116.99, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 116.99, "10th_percentile": 116.99, "90th_percentile": 116.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 104.61, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 104.61, "10th_percentile": 104.61, "90th_percentile": 104.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 104.4, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 104.4, "10th_percentile": 104.4, "90th_percentile": 104.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 129.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 129.15, "10th_percentile": 129.15, "90th_percentile": 129.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 139.91, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 139.91, "10th_percentile": 139.91, "90th_percentile": 139.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 139.91, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 139.91, "10th_percentile": 139.91, "90th_percentile": 139.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 129.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 129.15, "10th_percentile": 129.15, "90th_percentile": 129.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 125.79, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 125.79, "10th_percentile": 125.79, "90th_percentile": 125.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 124.16, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 124.16, "10th_percentile": 124.16, "90th_percentile": 124.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 109.69, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 109.69, "10th_percentile": 109.69, "90th_percentile": 109.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 120.32, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 120.32, "10th_percentile": 120.32, "90th_percentile": 120.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 104.46, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 104.46, "10th_percentile": 104.46, "90th_percentile": 104.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 104.46, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 104.46, "10th_percentile": 104.46, "90th_percentile": 104.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 215.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 215.25, "10th_percentile": 215.25, "90th_percentile": 215.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 215.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 215.25, "10th_percentile": 215.25, "90th_percentile": 215.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 215.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 215.25, "10th_percentile": 215.25, "90th_percentile": 215.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 215.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 215.25, "10th_percentile": 215.25, "90th_percentile": 215.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 215.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 215.25, "10th_percentile": 215.25, "90th_percentile": 215.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 215.25, "10th_percentile": 215.25, "90th_percentile": 215.25, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 215.25, "10th_percentile": 215.25, "90th_percentile": 215.25, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 215.25, "10th_percentile": 215.25, "90th_percentile": 215.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BISACODYL 10 MG RECT SUPP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-1080", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "00574-7050-50", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.74, "maximum": 1.75, "setting": "outpatient", "gross_charge": 1.75, "discounted_cash": 1.22, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1.75 @ 12.5% = $0.22 due to $0.00 Claim Price", "median_amount": 0.22, "10th_percentile": 0.22, "90th_percentile": 0.22, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1.75 @ 12.5% = $0.22 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1.75 @ 12.5% = $0.22 due to $0.00 Claim Price", "median_amount": 0.22, "10th_percentile": 0.22, "90th_percentile": 0.22, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1.75 @ 12.5% = $0.22 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1.75 @ 12.5% = $0.22 due to $0.00 Claim Price", "median_amount": 0.22, "10th_percentile": 0.22, "90th_percentile": 0.22, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1.75 @ 12.5% = $0.22 due to $0.00 Claim Price" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 1.75, "10th_percentile": 1.75, "90th_percentile": 1.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.75, "10th_percentile": 1.75, "90th_percentile": 1.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.75, "10th_percentile": 1.75, "90th_percentile": 1.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.75, "10th_percentile": 1.75, "90th_percentile": 1.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.75, "10th_percentile": 1.75, "90th_percentile": 1.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.75, "10th_percentile": 1.75, "90th_percentile": 1.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.82, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 0.82, "10th_percentile": 0.82, "90th_percentile": 0.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.74, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.74, "10th_percentile": 0.74, "90th_percentile": 0.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1.02, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.02, "10th_percentile": 1.02, "90th_percentile": 1.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 1.07, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 1.07, "10th_percentile": 1.07, "90th_percentile": 1.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 0.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 0.88, "10th_percentile": 0.88, "90th_percentile": 0.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 1.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 1.17, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.17, "10th_percentile": 1.17, "90th_percentile": 1.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 1.52, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 1.52, "10th_percentile": 1.52, "90th_percentile": 1.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 1.1, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 1.1, "10th_percentile": 1.1, "90th_percentile": 1.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 1.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1.05, "10th_percentile": 1.05, "90th_percentile": 1.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 1.14, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 1.14, "10th_percentile": 1.14, "90th_percentile": 1.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 1.05, "10th_percentile": 1.05, "90th_percentile": 1.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.74, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.74, "10th_percentile": 0.74, "90th_percentile": 0.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 1.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "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; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 0.95, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 0.95, "10th_percentile": 0.95, "90th_percentile": 0.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 0.85, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.85, "10th_percentile": 0.85, "90th_percentile": 0.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 0.95, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 0.95, "10th_percentile": 0.95, "90th_percentile": 0.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 0.95, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 0.95, "10th_percentile": 0.95, "90th_percentile": 0.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 0.95, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 0.95, "10th_percentile": 0.95, "90th_percentile": 0.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1.02, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.02, "10th_percentile": 1.02, "90th_percentile": 1.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 0.98, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 0.98, "10th_percentile": 0.98, "90th_percentile": 0.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 1.07, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 1.07, "10th_percentile": 1.07, "90th_percentile": 1.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 1.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1.05, "10th_percentile": 1.05, "90th_percentile": 1.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 1.14, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 1.14, "10th_percentile": 1.14, "90th_percentile": 1.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 1.14, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 1.14, "10th_percentile": 1.14, "90th_percentile": 1.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 1.05, "10th_percentile": 1.05, "90th_percentile": 1.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" } ] } ] }, { "description": "BRIMONIDINE 0.2 % OPHT DROP", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "RX-17881", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "24208-0411-05", "type": "NDC" } ], "standard_charges": [ { "minimum": 21.42, "maximum": 51.0, "setting": "outpatient", "gross_charge": 51.0, "discounted_cash": 35.7, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 24.75, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 24.75, "10th_percentile": 24.75, "90th_percentile": 24.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 24.75, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 24.75, "10th_percentile": 24.75, "90th_percentile": 24.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 30.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 30.6, "10th_percentile": 30.6, "90th_percentile": 30.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 28.51, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 28.51, "10th_percentile": 28.51, "90th_percentile": 28.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 29.8, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.8, "10th_percentile": 29.8, "90th_percentile": 29.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 29.42, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 29.42, "10th_percentile": 29.42, "90th_percentile": 29.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 25.99, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 25.99, "10th_percentile": 25.99, "90th_percentile": 25.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 33.15, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 33.15, "10th_percentile": 33.15, "90th_percentile": 33.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 30.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 30.6, "10th_percentile": 30.6, "90th_percentile": 30.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 33.15, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 33.15, "10th_percentile": 33.15, "90th_percentile": 33.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 30.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.6, "10th_percentile": 30.6, "90th_percentile": 30.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 30.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 30.6, "10th_percentile": 30.6, "90th_percentile": 30.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 30.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 30.6, "10th_percentile": 30.6, "90th_percentile": 30.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 23.97, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 23.97, "10th_percentile": 23.97, "90th_percentile": 23.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 29.8, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.8, "10th_percentile": 29.8, "90th_percentile": 29.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 29.42, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 29.42, "10th_percentile": 29.42, "90th_percentile": 29.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 25.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 25.5, "10th_percentile": 25.5, "90th_percentile": 25.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 34.12, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 34.12, "10th_percentile": 34.12, "90th_percentile": 34.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 44.37, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 44.37, "10th_percentile": 44.37, "90th_percentile": 44.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 32.13, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 32.13, "10th_percentile": 32.13, "90th_percentile": 32.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 33.15, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 33.15, "10th_percentile": 33.15, "90th_percentile": 33.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 40.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 40.8, "10th_percentile": 40.8, "90th_percentile": 40.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 27.72, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 27.72, "10th_percentile": 27.72, "90th_percentile": 27.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 24.79, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 24.79, "10th_percentile": 24.79, "90th_percentile": 24.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 24.74, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 21.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 21.42, "10th_percentile": 21.42, "90th_percentile": 21.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 21.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 21.42, "10th_percentile": 21.42, "90th_percentile": 21.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 51.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 51.0, "10th_percentile": 51.0, "90th_percentile": 51.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 51.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 51.0, "10th_percentile": 51.0, "90th_percentile": 51.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 51.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 51.0, "10th_percentile": 51.0, "90th_percentile": 51.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 51.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 51.0, "10th_percentile": 51.0, "90th_percentile": 51.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 51.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 51.0, "10th_percentile": 51.0, "90th_percentile": 51.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 51.0, "10th_percentile": 51.0, "90th_percentile": 51.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 51.0, "10th_percentile": 51.0, "90th_percentile": 51.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 51.0, "10th_percentile": 51.0, "90th_percentile": 51.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BUDESONIDE 0.25 MG/2 ML INH NBSP", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "RX-28774", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00115-1687-74", "type": "NDC" } ], "standard_charges": [ { "minimum": 42.84, "maximum": 102.0, "setting": "outpatient", "gross_charge": 102.0, "discounted_cash": 71.4, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 49.5, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 49.5, "10th_percentile": 49.5, "90th_percentile": 49.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 49.5, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 49.5, "10th_percentile": 49.5, "90th_percentile": 49.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 61.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 61.2, "10th_percentile": 61.2, "90th_percentile": 61.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 57.02, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 57.02, "10th_percentile": 57.02, "90th_percentile": 57.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 59.61, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.61, "10th_percentile": 59.61, "90th_percentile": 59.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 58.83, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 58.83, "10th_percentile": 58.83, "90th_percentile": 58.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 51.98, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 51.98, "10th_percentile": 51.98, "90th_percentile": 51.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 66.3, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 66.3, "10th_percentile": 66.3, "90th_percentile": 66.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 61.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 61.2, "10th_percentile": 61.2, "90th_percentile": 61.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 66.3, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 66.3, "10th_percentile": 66.3, "90th_percentile": 66.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 51.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 51.0, "10th_percentile": 51.0, "90th_percentile": 51.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH UHC CORE", "standard_charge_dollar": 49.47, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.47, "10th_percentile": 49.47, "90th_percentile": 49.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 64.26, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 64.26, "10th_percentile": 64.26, "90th_percentile": 64.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 47.94, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 47.94, "10th_percentile": 47.94, "90th_percentile": 47.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 59.61, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.61, "10th_percentile": 59.61, "90th_percentile": 59.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 58.83, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 58.83, "10th_percentile": 58.83, "90th_percentile": 58.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 88.74, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 88.74, "10th_percentile": 88.74, "90th_percentile": 88.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 68.24, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.24, "10th_percentile": 68.24, "90th_percentile": 68.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 66.3, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 66.3, "10th_percentile": 66.3, "90th_percentile": 66.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 55.44, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 55.44, "10th_percentile": 55.44, "90th_percentile": 55.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 81.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 81.6, "10th_percentile": 81.6, "90th_percentile": 81.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 49.57, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.57, "10th_percentile": 49.57, "90th_percentile": 49.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 61.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 61.2, "10th_percentile": 61.2, "90th_percentile": 61.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 61.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 61.2, "10th_percentile": 61.2, "90th_percentile": 61.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 61.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 61.2, "10th_percentile": 61.2, "90th_percentile": 61.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 42.84, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 42.84, "10th_percentile": 42.84, "90th_percentile": 42.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 42.84, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 42.84, "10th_percentile": 42.84, "90th_percentile": 42.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BUDESONIDE 0.25 MG/2 ML INH NBSP", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "RX-28774", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "69097-0318-86", "type": "NDC" } ], "standard_charges": [ { "minimum": 10.5, "maximum": 25.0, "setting": "outpatient", "gross_charge": 25.0, "discounted_cash": 17.5, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 12.13, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 12.13, "10th_percentile": 12.13, "90th_percentile": 12.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 12.13, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 12.13, "10th_percentile": 12.13, "90th_percentile": 12.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 15.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 15.0, "10th_percentile": 15.0, "90th_percentile": 15.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 13.98, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 13.98, "10th_percentile": 13.98, "90th_percentile": 13.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 14.61, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.61, "10th_percentile": 14.61, "90th_percentile": 14.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 14.42, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 14.42, "10th_percentile": 14.42, "90th_percentile": 14.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 12.74, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 12.74, "10th_percentile": 12.74, "90th_percentile": 12.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 16.25, "10th_percentile": 16.25, "90th_percentile": 16.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 15.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 15.0, "10th_percentile": 15.0, "90th_percentile": 15.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 16.25, "10th_percentile": 16.25, "90th_percentile": 16.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 12.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 12.5, "10th_percentile": 12.5, "90th_percentile": 12.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH UHC CORE", "standard_charge_dollar": 12.13, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.13, "10th_percentile": 12.13, "90th_percentile": 12.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 15.75, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 15.75, "10th_percentile": 15.75, "90th_percentile": 15.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 11.75, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 11.75, "10th_percentile": 11.75, "90th_percentile": 11.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 14.61, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.61, "10th_percentile": 14.61, "90th_percentile": 14.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 14.42, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 14.42, "10th_percentile": 14.42, "90th_percentile": 14.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 21.75, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 21.75, "10th_percentile": 21.75, "90th_percentile": 21.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 16.73, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 16.73, "10th_percentile": 16.73, "90th_percentile": 16.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 16.25, "10th_percentile": 16.25, "90th_percentile": 16.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 13.59, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 13.59, "10th_percentile": 13.59, "90th_percentile": 13.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 20.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 20.0, "10th_percentile": 20.0, "90th_percentile": 20.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 12.15, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.15, "10th_percentile": 12.15, "90th_percentile": 12.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 15.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 15.0, "10th_percentile": 15.0, "90th_percentile": 15.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 15.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15.0, "10th_percentile": 15.0, "90th_percentile": 15.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 15.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 15.0, "10th_percentile": 15.0, "90th_percentile": 15.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 10.5, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 10.5, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 25.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 25.0, "10th_percentile": 25.0, "90th_percentile": 25.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 25.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 25.0, "10th_percentile": 25.0, "90th_percentile": 25.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 25.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 25.0, "10th_percentile": 25.0, "90th_percentile": 25.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 25.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 25.0, "10th_percentile": 25.0, "90th_percentile": 25.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 25.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 25.0, "10th_percentile": 25.0, "90th_percentile": 25.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 25.0, "10th_percentile": 25.0, "90th_percentile": 25.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 25.0, "10th_percentile": 25.0, "90th_percentile": 25.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 25.0, "10th_percentile": 25.0, "90th_percentile": 25.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BUDESONIDE 1 MG/2 ML INH NBSP", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "RX-102320", "type": "CDM" }, { "code": "63600000", "type": "LOCAL" }, { "code": "0636", "type": "RC" }, { "code": "00781-7517-14", "type": "NDC" } ], "standard_charges": [ { "minimum": 54.18, "maximum": 129.0, "setting": "outpatient", "gross_charge": 129.0, "discounted_cash": 90.3, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 129.0, "10th_percentile": 129.0, "90th_percentile": 129.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 129.0, "10th_percentile": 129.0, "90th_percentile": 129.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 129.0, "10th_percentile": 129.0, "90th_percentile": 129.0, "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": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 65.74, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 65.74, "10th_percentile": 65.74, "90th_percentile": 65.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 62.6, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 62.6, "10th_percentile": 62.6, "90th_percentile": 62.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 62.6, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 62.6, "10th_percentile": 62.6, "90th_percentile": 62.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 75.39, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 75.39, "10th_percentile": 75.39, "90th_percentile": 75.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 72.11, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 72.11, "10th_percentile": 72.11, "90th_percentile": 72.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 74.41, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 74.41, "10th_percentile": 74.41, "90th_percentile": 74.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 77.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 77.4, "10th_percentile": 77.4, "90th_percentile": 77.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 83.85, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 83.85, "10th_percentile": 83.85, "90th_percentile": 83.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 83.85, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 83.85, "10th_percentile": 83.85, "90th_percentile": 83.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 77.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 77.4, "10th_percentile": 77.4, "90th_percentile": 77.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 72.5, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 72.5, "10th_percentile": 72.5, "90th_percentile": 72.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 60.63, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 60.63, "10th_percentile": 60.63, "90th_percentile": 60.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 54.18, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 54.18, "10th_percentile": 54.18, "90th_percentile": 54.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 129.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 129.0, "10th_percentile": 129.0, "90th_percentile": 129.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 75.39, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 75.39, "10th_percentile": 75.39, "90th_percentile": 75.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 74.41, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 74.41, "10th_percentile": 74.41, "90th_percentile": 74.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 64.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 64.5, "10th_percentile": 64.5, "90th_percentile": 64.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 77.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 77.4, "10th_percentile": 77.4, "90th_percentile": 77.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH AETNA", "standard_charge_dollar": 72.5, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 72.5, "10th_percentile": 72.5, "90th_percentile": 72.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 86.3, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 86.3, "10th_percentile": 86.3, "90th_percentile": 86.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 129.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 129.0, "10th_percentile": 129.0, "90th_percentile": 129.0, "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": "MRH HFN", "standard_charge_dollar": 112.23, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 112.23, "10th_percentile": 112.23, "90th_percentile": 112.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 81.27, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 81.27, "10th_percentile": 81.27, "90th_percentile": 81.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 77.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 77.4, "10th_percentile": 77.4, "90th_percentile": 77.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 83.85, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 83.85, "10th_percentile": 83.85, "90th_percentile": 83.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 129.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 129.0, "10th_percentile": 129.0, "90th_percentile": 129.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 77.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 77.4, "10th_percentile": 77.4, "90th_percentile": 77.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 54.18, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 54.18, "10th_percentile": 54.18, "90th_percentile": 54.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 129.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 129.0, "10th_percentile": 129.0, "90th_percentile": 129.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 103.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 103.2, "10th_percentile": 103.2, "90th_percentile": 103.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 70.11, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 70.11, "10th_percentile": 70.11, "90th_percentile": 70.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 129.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 129.0, "10th_percentile": 129.0, "90th_percentile": 129.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 62.69, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 62.69, "10th_percentile": 62.69, "90th_percentile": 62.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 62.57, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 62.57, "10th_percentile": 62.57, "90th_percentile": 62.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "BUDESONIDE 1 MG/2 ML INH NBSP", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "RX-102320", "type": "CDM" }, { "code": "63600000", "type": "LOCAL" }, { "code": "0636", "type": "RC" }, { "code": "00781-7517-87", "type": "NDC" } ], "standard_charges": [ { "minimum": 54.18, "maximum": 129.0, "setting": "outpatient", "gross_charge": 129.0, "discounted_cash": 90.3, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 129.0, "10th_percentile": 129.0, "90th_percentile": 129.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 129.0, "10th_percentile": 129.0, "90th_percentile": 129.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 129.0, "10th_percentile": 129.0, "90th_percentile": 129.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 72.5, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 72.5, "10th_percentile": 72.5, "90th_percentile": 72.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 60.63, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 60.63, "10th_percentile": 60.63, "90th_percentile": 60.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 54.18, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 54.18, "10th_percentile": 54.18, "90th_percentile": 54.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 129.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 129.0, "10th_percentile": 129.0, "90th_percentile": 129.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 75.39, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 75.39, "10th_percentile": 75.39, "90th_percentile": 75.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 74.41, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 74.41, "10th_percentile": 74.41, "90th_percentile": 74.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 64.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 64.5, "10th_percentile": 64.5, "90th_percentile": 64.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 77.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 77.4, "10th_percentile": 77.4, "90th_percentile": 77.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH AETNA", "standard_charge_dollar": 72.5, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 72.5, "10th_percentile": 72.5, "90th_percentile": 72.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 86.3, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 86.3, "10th_percentile": 86.3, "90th_percentile": 86.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 129.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 129.0, "10th_percentile": 129.0, "90th_percentile": 129.0, "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": "MRH HFN", "standard_charge_dollar": 112.23, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 112.23, "10th_percentile": 112.23, "90th_percentile": 112.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 81.27, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 81.27, "10th_percentile": 81.27, "90th_percentile": 81.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 77.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 77.4, "10th_percentile": 77.4, "90th_percentile": 77.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 83.85, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 83.85, "10th_percentile": 83.85, "90th_percentile": 83.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 129.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 129.0, "10th_percentile": 129.0, "90th_percentile": 129.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 77.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 77.4, "10th_percentile": 77.4, "90th_percentile": 77.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 54.18, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 54.18, "10th_percentile": 54.18, "90th_percentile": 54.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 129.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 129.0, "10th_percentile": 129.0, "90th_percentile": 129.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 103.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 103.2, "10th_percentile": 103.2, "90th_percentile": 103.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 70.11, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 70.11, "10th_percentile": 70.11, "90th_percentile": 70.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 129.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 129.0, "10th_percentile": 129.0, "90th_percentile": 129.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 62.69, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 62.69, "10th_percentile": 62.69, "90th_percentile": 62.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 62.57, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 62.57, "10th_percentile": 62.57, "90th_percentile": 62.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 65.74, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 65.74, "10th_percentile": 65.74, "90th_percentile": 65.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 62.6, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 62.6, "10th_percentile": 62.6, "90th_percentile": 62.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 62.6, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 62.6, "10th_percentile": 62.6, "90th_percentile": 62.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 75.39, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 75.39, "10th_percentile": 75.39, "90th_percentile": 75.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 72.11, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 72.11, "10th_percentile": 72.11, "90th_percentile": 72.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 74.41, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 74.41, "10th_percentile": 74.41, "90th_percentile": 74.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 77.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 77.4, "10th_percentile": 77.4, "90th_percentile": 77.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 83.85, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 83.85, "10th_percentile": 83.85, "90th_percentile": 83.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 83.85, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 83.85, "10th_percentile": 83.85, "90th_percentile": 83.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 77.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 77.4, "10th_percentile": 77.4, "90th_percentile": 77.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" } ] } ] }, { "description": "BUMETANIDE 0.5 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-9309", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "42799-0119-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.79, "maximum": 4.25, "setting": "outpatient", "gross_charge": 4.25, "discounted_cash": 2.97, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.76, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 2.76, "10th_percentile": 2.76, "90th_percentile": 2.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 2.55, "10th_percentile": 2.55, "90th_percentile": 2.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.38, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.38, "10th_percentile": 2.38, "90th_percentile": 2.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.48, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.45, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.45, "10th_percentile": 2.45, "90th_percentile": 2.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.76, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.76, "10th_percentile": 2.76, "90th_percentile": 2.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.17, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 2.55, "10th_percentile": 2.55, "90th_percentile": 2.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2.06, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 2.06, "10th_percentile": 2.06, "90th_percentile": 2.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2.06, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 2.06, "10th_percentile": 2.06, "90th_percentile": 2.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2.0, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% 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 Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.48, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 2.45, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.45, "10th_percentile": 2.45, "90th_percentile": 2.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.13, "10th_percentile": 2.13, "90th_percentile": 2.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.84, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.84, "10th_percentile": 2.84, "90th_percentile": 2.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.7, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.7, "10th_percentile": 3.7, "90th_percentile": 3.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.68, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.76, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.76, "10th_percentile": 2.76, "90th_percentile": 2.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 3.4, "10th_percentile": 3.4, "90th_percentile": 3.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.31, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 2.07, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.07, "10th_percentile": 2.07, "90th_percentile": 2.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 2.06, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.06, "10th_percentile": 2.06, "90th_percentile": 2.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 2.55, "10th_percentile": 2.55, "90th_percentile": 2.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.55, "10th_percentile": 2.55, "90th_percentile": 2.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 2.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 2.55, "10th_percentile": 2.55, "90th_percentile": 2.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.79, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.79, "10th_percentile": 1.79, "90th_percentile": 1.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.79, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.79, "10th_percentile": 1.79, "90th_percentile": 1.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4.25, "10th_percentile": 4.25, "90th_percentile": 4.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4.25, "10th_percentile": 4.25, "90th_percentile": 4.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4.25, "10th_percentile": 4.25, "90th_percentile": 4.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4.25, "10th_percentile": 4.25, "90th_percentile": 4.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4.25, "10th_percentile": 4.25, "90th_percentile": 4.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4.25, "10th_percentile": 4.25, "90th_percentile": 4.25, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4.25, "10th_percentile": 4.25, "90th_percentile": 4.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4.25, "10th_percentile": 4.25, "90th_percentile": 4.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BUPRENORPHINE-NALOXONE 8-2 MG SL FILM", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-184166", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00378-8767-16", "type": "NDC" } ], "standard_charges": [ { "minimum": 14.6, "maximum": 34.75, "setting": "outpatient", "gross_charge": 34.75, "discounted_cash": 24.32, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 22.59, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 22.59, "10th_percentile": 22.59, "90th_percentile": 22.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 20.85, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 20.85, "10th_percentile": 20.85, "90th_percentile": 20.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 19.43, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 19.43, "10th_percentile": 19.43, "90th_percentile": 19.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 20.31, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.31, "10th_percentile": 20.31, "90th_percentile": 20.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 20.04, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 20.04, "10th_percentile": 20.04, "90th_percentile": 20.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 22.59, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 22.59, "10th_percentile": 22.59, "90th_percentile": 22.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 17.71, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 17.71, "10th_percentile": 17.71, "90th_percentile": 17.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 20.85, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 20.85, "10th_percentile": 20.85, "90th_percentile": 20.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 16.86, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 16.86, "10th_percentile": 16.86, "90th_percentile": 16.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 16.86, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 16.86, "10th_percentile": 16.86, "90th_percentile": 16.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 16.33, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 16.33, "10th_percentile": 16.33, "90th_percentile": 16.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 20.31, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.31, "10th_percentile": 20.31, "90th_percentile": 20.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 20.04, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 20.04, "10th_percentile": 20.04, "90th_percentile": 20.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 17.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 17.38, "10th_percentile": 17.38, "90th_percentile": 17.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 23.25, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.25, "10th_percentile": 23.25, "90th_percentile": 23.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 30.23, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 30.23, "10th_percentile": 30.23, "90th_percentile": 30.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 21.89, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 21.89, "10th_percentile": 21.89, "90th_percentile": 21.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 22.59, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 22.59, "10th_percentile": 22.59, "90th_percentile": 22.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 27.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 27.8, "10th_percentile": 27.8, "90th_percentile": 27.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 18.89, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 18.89, "10th_percentile": 18.89, "90th_percentile": 18.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 16.89, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 16.89, "10th_percentile": 16.89, "90th_percentile": 16.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 16.85, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 16.85, "10th_percentile": 16.85, "90th_percentile": 16.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 20.85, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 20.85, "10th_percentile": 20.85, "90th_percentile": 20.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 20.85, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.85, "10th_percentile": 20.85, "90th_percentile": 20.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 20.85, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 20.85, "10th_percentile": 20.85, "90th_percentile": 20.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 14.6, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 14.6, "10th_percentile": 14.6, "90th_percentile": 14.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 14.6, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 14.6, "10th_percentile": 14.6, "90th_percentile": 14.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 34.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 34.75, "10th_percentile": 34.75, "90th_percentile": 34.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 34.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 34.75, "10th_percentile": 34.75, "90th_percentile": 34.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 34.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 34.75, "10th_percentile": 34.75, "90th_percentile": 34.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 34.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 34.75, "10th_percentile": 34.75, "90th_percentile": 34.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 34.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 34.75, "10th_percentile": 34.75, "90th_percentile": 34.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 34.75, "10th_percentile": 34.75, "90th_percentile": 34.75, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 34.75, "10th_percentile": 34.75, "90th_percentile": 34.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 34.75, "10th_percentile": 34.75, "90th_percentile": 34.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BUPROPION HCL 150 MG ORAL TB24", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-36775", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "68180-0319-09", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "BUSPIRONE 5 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-9324", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "68382-0180-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-30961", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "68084-0479-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 5.25, "maximum": 12.5, "setting": "outpatient", "gross_charge": 12.5, "discounted_cash": 8.75, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 8.13, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 8.13, "10th_percentile": 8.13, "90th_percentile": 8.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 7.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 7.5, "10th_percentile": 7.5, "90th_percentile": 7.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 6.99, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 6.99, "10th_percentile": 6.99, "90th_percentile": 6.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 7.31, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.31, "10th_percentile": 7.31, "90th_percentile": 7.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 7.21, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 7.21, "10th_percentile": 7.21, "90th_percentile": 7.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 8.13, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 8.13, "10th_percentile": 8.13, "90th_percentile": 8.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 6.37, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 6.37, "10th_percentile": 6.37, "90th_percentile": 6.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 7.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 7.5, "10th_percentile": 7.5, "90th_percentile": 7.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 6.07, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 6.07, "10th_percentile": 6.07, "90th_percentile": 6.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 6.07, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 6.07, "10th_percentile": 6.07, "90th_percentile": 6.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 5.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 5.88, "10th_percentile": 5.88, "90th_percentile": 5.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 7.31, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.31, "10th_percentile": 7.31, "90th_percentile": 7.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 7.21, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 7.21, "10th_percentile": 7.21, "90th_percentile": 7.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 6.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 6.25, "10th_percentile": 6.25, "90th_percentile": 6.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 8.36, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.36, "10th_percentile": 8.36, "90th_percentile": 8.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 10.88, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 10.88, "10th_percentile": 10.88, "90th_percentile": 10.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 7.88, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 7.88, "10th_percentile": 7.88, "90th_percentile": 7.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 8.13, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 8.13, "10th_percentile": 8.13, "90th_percentile": 8.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 10.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 6.79, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 6.79, "10th_percentile": 6.79, "90th_percentile": 6.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 6.08, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.08, "10th_percentile": 6.08, "90th_percentile": 6.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 6.06, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.06, "10th_percentile": 6.06, "90th_percentile": 6.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 7.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 7.5, "10th_percentile": 7.5, "90th_percentile": 7.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 7.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.5, "10th_percentile": 7.5, "90th_percentile": 7.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 7.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 7.5, "10th_percentile": 7.5, "90th_percentile": 7.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 5.25, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 5.25, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "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": "MRH MEDICARE", "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": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "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": "CALCIUM CARBONATE 200 MG CALCIUM (500 MG) ORAL CHEW", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-9385", "type": "CDM" }, { "code": "J8499", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "69618-0020-15", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.47, "maximum": 1.0, "setting": "outpatient", "gross_charge": 1.0, "discounted_cash": 0.7, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "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": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 0.55, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "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); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 0.55, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "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); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 0.55, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "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); 54.5% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 0.61, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 0.61, "10th_percentile": 0.61, "90th_percentile": 0.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 0.61, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 0.61, "10th_percentile": 0.61, "90th_percentile": 0.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 0.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.47, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 0.47, "10th_percentile": 0.47, "90th_percentile": 0.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 0.56, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 0.56, "10th_percentile": 0.56, "90th_percentile": 0.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 0.54, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1.00 @ 12.5% = $0.13 due to $0.00 Claim Price", "median_amount": 0.13, "10th_percentile": 0.13, "90th_percentile": 0.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1.00 @ 12.5% = $0.13 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1.00 @ 12.5% = $0.13 due to $0.00 Claim Price", "median_amount": 0.13, "10th_percentile": 0.13, "90th_percentile": 0.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1.00 @ 12.5% = $0.13 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1.00 @ 12.5% = $0.13 due to $0.00 Claim Price", "median_amount": 0.13, "10th_percentile": 0.13, "90th_percentile": 0.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1.00 @ 12.5% = $0.13 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_algorithm": "No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_algorithm": "No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_algorithm": "No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH AETNA", "standard_charge_algorithm": "No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_algorithm": "No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_algorithm": "No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_algorithm": "No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_algorithm": "No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_algorithm": "No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_algorithm": "No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_algorithm": "No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" } ] } ] }, { "description": "CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "RX-1312", "type": "CDM" }, { "code": "J0612", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "63323-0360-19", "type": "NDC" } ], "standard_charges": [ { "minimum": 22.79, "maximum": 54.25, "setting": "outpatient", "gross_charge": 54.25, "discounted_cash": 37.97, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $54.25 @ 12.5% = $6.78 due to $0.00 Claim Price", "median_amount": 6.78, "10th_percentile": 6.78, "90th_percentile": 6.78, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $54.25 @ 12.5% = $6.78 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $54.25 @ 12.5% = $6.78 due to $0.00 Claim Price", "median_amount": 6.78, "10th_percentile": 6.78, "90th_percentile": 6.78, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $54.25 @ 12.5% = $6.78 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $54.25 @ 12.5% = $6.78 due to $0.00 Claim Price", "median_amount": 6.78, "10th_percentile": 6.78, "90th_percentile": 6.78, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $54.25 @ 12.5% = $6.78 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 54.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 54.25, "10th_percentile": 54.25, "90th_percentile": 54.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 54.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 54.25, "10th_percentile": 54.25, "90th_percentile": 54.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 54.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 54.25, "10th_percentile": 54.25, "90th_percentile": 54.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 54.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 54.25, "10th_percentile": 54.25, "90th_percentile": 54.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 54.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 54.25, "10th_percentile": 54.25, "90th_percentile": 54.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 30.49, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 30.49, "10th_percentile": 30.49, "90th_percentile": 30.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH AETNA", "standard_charge_dollar": 30.49, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 30.49, "10th_percentile": 30.49, "90th_percentile": 30.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 32.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 32.55, "10th_percentile": 32.55, "90th_percentile": 32.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 32.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 32.55, "10th_percentile": 32.55, "90th_percentile": 32.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 32.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 32.55, "10th_percentile": 32.55, "90th_percentile": 32.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 36.29, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 36.29, "10th_percentile": 36.29, "90th_percentile": 36.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 26.31, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.31, "10th_percentile": 26.31, "90th_percentile": 26.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS HMO", "standard_charge_dollar": 31.7, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 31.7, "10th_percentile": 31.7, "90th_percentile": 31.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 26.37, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.37, "10th_percentile": 26.37, "90th_percentile": 26.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH PHCS", "standard_charge_dollar": 43.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 43.4, "10th_percentile": 43.4, "90th_percentile": 43.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 27.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 27.13, "10th_percentile": 27.13, "90th_percentile": 27.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 34.18, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 34.18, "10th_percentile": 34.18, "90th_percentile": 34.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 29.48, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 29.48, "10th_percentile": 29.48, "90th_percentile": 29.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 47.2, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 47.2, "10th_percentile": 47.2, "90th_percentile": 47.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 35.26, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 35.26, "10th_percentile": 35.26, "90th_percentile": 35.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 25.5, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 25.5, "10th_percentile": 25.5, "90th_percentile": 25.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 33.31, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 33.31, "10th_percentile": 33.31, "90th_percentile": 33.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 22.79, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 22.79, "10th_percentile": 22.79, "90th_percentile": 22.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 22.79, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 22.79, "10th_percentile": 22.79, "90th_percentile": 22.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 29.57, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 29.57, "10th_percentile": 29.57, "90th_percentile": 29.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 29.57, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 29.57, "10th_percentile": 29.57, "90th_percentile": 29.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 29.57, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 29.57, "10th_percentile": 29.57, "90th_percentile": 29.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 30.33, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 30.33, "10th_percentile": 30.33, "90th_percentile": 30.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 31.7, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 31.7, "10th_percentile": 31.7, "90th_percentile": 31.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 35.26, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 35.26, "10th_percentile": 35.26, "90th_percentile": 35.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 32.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 32.55, "10th_percentile": 32.55, "90th_percentile": 32.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 33.31, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 33.31, "10th_percentile": 33.31, "90th_percentile": 33.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 32.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 32.55, "10th_percentile": 32.55, "90th_percentile": 32.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 35.26, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 35.26, "10th_percentile": 35.26, "90th_percentile": 35.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" } ] } ] }, { "description": "CAPTOPRIL 50 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-9403", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "69292-0526-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 10.61, "maximum": 25.25, "setting": "outpatient", "gross_charge": 25.25, "discounted_cash": 17.67, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 16.41, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 16.41, "10th_percentile": 16.41, "90th_percentile": 16.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 15.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 15.15, "10th_percentile": 15.15, "90th_percentile": 15.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 14.11, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 14.11, "10th_percentile": 14.11, "90th_percentile": 14.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 14.76, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.76, "10th_percentile": 14.76, "90th_percentile": 14.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 14.56, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 14.56, "10th_percentile": 14.56, "90th_percentile": 14.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 16.41, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 16.41, "10th_percentile": 16.41, "90th_percentile": 16.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 12.87, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 12.87, "10th_percentile": 12.87, "90th_percentile": 12.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 15.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 15.15, "10th_percentile": 15.15, "90th_percentile": 15.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 12.25, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 12.25, "10th_percentile": 12.25, "90th_percentile": 12.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 12.25, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 12.25, "10th_percentile": 12.25, "90th_percentile": 12.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 11.87, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 11.87, "10th_percentile": 11.87, "90th_percentile": 11.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 14.76, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.76, "10th_percentile": 14.76, "90th_percentile": 14.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 14.56, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 14.56, "10th_percentile": 14.56, "90th_percentile": 14.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 12.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 12.63, "10th_percentile": 12.63, "90th_percentile": 12.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 16.89, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 16.89, "10th_percentile": 16.89, "90th_percentile": 16.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 21.97, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 21.97, "10th_percentile": 21.97, "90th_percentile": 21.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 15.91, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 15.91, "10th_percentile": 15.91, "90th_percentile": 15.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 16.41, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 16.41, "10th_percentile": 16.41, "90th_percentile": 16.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 20.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 20.2, "10th_percentile": 20.2, "90th_percentile": 20.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 13.72, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 13.72, "10th_percentile": 13.72, "90th_percentile": 13.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 12.27, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.27, "10th_percentile": 12.27, "90th_percentile": 12.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 12.25, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.25, "10th_percentile": 12.25, "90th_percentile": 12.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 15.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 15.15, "10th_percentile": 15.15, "90th_percentile": 15.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 15.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15.15, "10th_percentile": 15.15, "90th_percentile": 15.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 15.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 15.15, "10th_percentile": 15.15, "90th_percentile": 15.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 10.61, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 10.61, "10th_percentile": 10.61, "90th_percentile": 10.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 10.61, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 10.61, "10th_percentile": 10.61, "90th_percentile": 10.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 25.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 25.25, "10th_percentile": 25.25, "90th_percentile": 25.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 25.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 25.25, "10th_percentile": 25.25, "90th_percentile": 25.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 25.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 25.25, "10th_percentile": 25.25, "90th_percentile": 25.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 25.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 25.25, "10th_percentile": 25.25, "90th_percentile": 25.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 25.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 25.25, "10th_percentile": 25.25, "90th_percentile": 25.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 25.25, "10th_percentile": 25.25, "90th_percentile": 25.25, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 25.25, "10th_percentile": 25.25, "90th_percentile": 25.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 25.25, "10th_percentile": 25.25, "90th_percentile": 25.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CARBIDOPA-LEVODOPA 10-100 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-9406", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "62756-0517-88", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "CARBIDOPA-LEVODOPA 12.5-50 MG ORAL HALF TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-4080000016", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00000-0100-16", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.89, "maximum": 4.5, "setting": "outpatient", "gross_charge": 4.5, "discounted_cash": 3.15, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.93, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 2.7, "10th_percentile": 2.7, "90th_percentile": 2.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.52, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.63, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.63, "10th_percentile": 2.63, "90th_percentile": 2.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.6, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.93, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.93, "10th_percentile": 2.93, "90th_percentile": 2.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.29, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% 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; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2.18, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% 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; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2.18, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% 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; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2.12, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2.12, "10th_percentile": 2.12, "90th_percentile": 2.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.63, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.63, "10th_percentile": 2.63, "90th_percentile": 2.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 2.6, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 3.01, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.01, "10th_percentile": 3.01, "90th_percentile": 3.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.92, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.92, "10th_percentile": 3.92, "90th_percentile": 3.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.84, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.84, "10th_percentile": 2.84, "90th_percentile": 2.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.93, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.93, "10th_percentile": 2.93, "90th_percentile": 2.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% 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 Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.45, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.45, "10th_percentile": 2.45, "90th_percentile": 2.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 2.19, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.19, "10th_percentile": 2.19, "90th_percentile": 2.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 2.18, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 2.7, "10th_percentile": 2.7, "90th_percentile": 2.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.7, "10th_percentile": 2.7, "90th_percentile": 2.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 2.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.89, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.89, "10th_percentile": 1.89, "90th_percentile": 1.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.89, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.89, "10th_percentile": 1.89, "90th_percentile": 1.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4.5, "10th_percentile": 4.5, "90th_percentile": 4.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4.5, "10th_percentile": 4.5, "90th_percentile": 4.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4.5, "10th_percentile": 4.5, "90th_percentile": 4.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4.5, "10th_percentile": 4.5, "90th_percentile": 4.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4.5, "10th_percentile": 4.5, "90th_percentile": 4.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4.5, "10th_percentile": 4.5, "90th_percentile": 4.5, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4.5, "10th_percentile": 4.5, "90th_percentile": 4.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4.5, "10th_percentile": 4.5, "90th_percentile": 4.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CARBOXYMETHYLCELLULOSE SODIUM 1 % OPHT DPGE", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-101586", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00023-4554-30", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.05, "maximum": 2.5, "setting": "outpatient", "gross_charge": 2.5, "discounted_cash": 1.75, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 1.63, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 1.63, "10th_percentile": 1.63, "90th_percentile": 1.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 1.5, "10th_percentile": 1.5, "90th_percentile": 1.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1.4, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 1.4, "10th_percentile": 1.4, "90th_percentile": 1.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1.46, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 1.44, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 1.44, "10th_percentile": 1.44, "90th_percentile": 1.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 1.63, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% 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; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1.27, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 1.27, "10th_percentile": 1.27, "90th_percentile": 1.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 1.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1.5, "10th_percentile": 1.5, "90th_percentile": 1.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.21, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 1.21, "10th_percentile": 1.21, "90th_percentile": 1.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.21, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 1.21, "10th_percentile": 1.21, "90th_percentile": 1.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.18, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.18, "10th_percentile": 1.18, "90th_percentile": 1.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1.46, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 1.44, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 1.44, "10th_percentile": 1.44, "90th_percentile": 1.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 1.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 1.25, "10th_percentile": 1.25, "90th_percentile": 1.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 1.67, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 1.67, "90th_percentile": 1.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 2.18, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 2.18, "10th_percentile": 2.18, "90th_percentile": 2.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 1.58, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 1.58, "10th_percentile": 1.58, "90th_percentile": 1.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 1.63, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% 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; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 1.36, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 1.36, "10th_percentile": 1.36, "90th_percentile": 1.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.22, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.22, "10th_percentile": 1.22, "90th_percentile": 1.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.21, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.21, "10th_percentile": 1.21, "90th_percentile": 1.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 1.5, "10th_percentile": 1.5, "90th_percentile": 1.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 1.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.5, "10th_percentile": 1.5, "90th_percentile": 1.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 1.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1.5, "10th_percentile": 1.5, "90th_percentile": 1.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.05, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.05, "10th_percentile": 1.05, "90th_percentile": 1.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.05, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.05, "10th_percentile": 1.05, "90th_percentile": 1.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.5, "10th_percentile": 2.5, "90th_percentile": 2.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.5, "10th_percentile": 2.5, "90th_percentile": 2.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.5, "10th_percentile": 2.5, "90th_percentile": 2.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.5, "10th_percentile": 2.5, "90th_percentile": 2.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.5, "10th_percentile": 2.5, "90th_percentile": 2.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.5, "10th_percentile": 2.5, "90th_percentile": 2.5, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.5, "10th_percentile": 2.5, "90th_percentile": 2.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.5, "10th_percentile": 2.5, "90th_percentile": 2.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CARVEDILOL 3.125 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-18551", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "51079-0771-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "CARVEDILOL 3.125 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-18551", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "51079-0771-20", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "CEFEPIME 2 G INJ SOLR", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-16371", "type": "CDM" }, { "code": "J0692", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "60505-6147-00", "type": "NDC" } ], "standard_charges": [ { "minimum": 48.41, "maximum": 115.25, "setting": "outpatient", "gross_charge": 115.25, "discounted_cash": 80.67, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 115.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 115.25, "10th_percentile": 115.25, "90th_percentile": 115.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 115.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 115.25, "10th_percentile": 115.25, "90th_percentile": 115.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 115.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 115.25, "10th_percentile": 115.25, "90th_percentile": 115.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 115.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 115.25, "10th_percentile": 115.25, "90th_percentile": 115.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 115.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 115.25, "10th_percentile": 115.25, "90th_percentile": 115.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 74.91, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 74.91, "10th_percentile": 74.91, "90th_percentile": 74.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 72.61, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 72.61, "10th_percentile": 72.61, "90th_percentile": 72.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 100.27, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 100.27, "10th_percentile": 100.27, "90th_percentile": 100.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 92.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 92.2, "10th_percentile": 92.2, "90th_percentile": 92.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 77.1, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 77.1, "10th_percentile": 77.1, "90th_percentile": 77.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 55.9, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 55.9, "10th_percentile": 55.9, "90th_percentile": 55.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 57.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 57.63, "10th_percentile": 57.63, "90th_percentile": 57.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 67.35, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.35, "10th_percentile": 67.35, "90th_percentile": 67.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH THE ALLIANCE", "standard_charge_dollar": 62.64, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 62.64, "10th_percentile": 62.64, "90th_percentile": 62.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 56.01, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 56.01, "10th_percentile": 56.01, "90th_percentile": 56.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 54.17, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 54.17, "10th_percentile": 54.17, "90th_percentile": 54.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 70.76, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 70.76, "10th_percentile": 70.76, "90th_percentile": 70.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 69.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 69.15, "10th_percentile": 69.15, "90th_percentile": 69.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 69.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 69.15, "10th_percentile": 69.15, "90th_percentile": 69.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 69.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 69.15, "10th_percentile": 69.15, "90th_percentile": 69.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 64.77, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 64.77, "10th_percentile": 64.77, "90th_percentile": 64.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH AETNA", "standard_charge_dollar": 64.77, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 64.77, "10th_percentile": 64.77, "90th_percentile": 64.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 48.41, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 48.41, "10th_percentile": 48.41, "90th_percentile": 48.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 48.41, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 48.41, "10th_percentile": 48.41, "90th_percentile": 48.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 62.81, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 62.81, "10th_percentile": 62.81, "90th_percentile": 62.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 62.81, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 62.81, "10th_percentile": 62.81, "90th_percentile": 62.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 62.81, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 62.81, "10th_percentile": 62.81, "90th_percentile": 62.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 64.42, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 64.42, "10th_percentile": 64.42, "90th_percentile": 64.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 69.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 69.15, "10th_percentile": 69.15, "90th_percentile": 69.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 74.91, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 74.91, "10th_percentile": 74.91, "90th_percentile": 74.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 67.35, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.35, "10th_percentile": 67.35, "90th_percentile": 67.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 70.76, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 70.76, "10th_percentile": 70.76, "90th_percentile": 70.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 69.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 69.15, "10th_percentile": 69.15, "90th_percentile": 69.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 74.91, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 74.91, "10th_percentile": 74.91, "90th_percentile": 74.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $115.25 @ 12.5% = $14.41 due to $0.00 Claim Price", "median_amount": 14.41, "10th_percentile": 14.41, "90th_percentile": 14.41, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $115.25 @ 12.5% = $14.41 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $115.25 @ 12.5% = $14.41 due to $0.00 Claim Price", "median_amount": 14.41, "10th_percentile": 14.41, "90th_percentile": 14.41, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $115.25 @ 12.5% = $14.41 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $115.25 @ 12.5% = $14.41 due to $0.00 Claim Price", "median_amount": 14.41, "10th_percentile": 14.41, "90th_percentile": 14.41, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $115.25 @ 12.5% = $14.41 due to $0.00 Claim Price" } ] } ] }, { "description": "CEFTRIAXONE 2 G INJ SOLR", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-88360", "type": "CDM" }, { "code": "J0696", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00781-3209-95", "type": "NDC" } ], "standard_charges": [ { "minimum": 13.65, "maximum": 32.5, "setting": "outpatient", "gross_charge": 32.5, "discounted_cash": 22.75, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 32.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 32.5, "10th_percentile": 32.5, "90th_percentile": 32.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 32.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 32.5, "10th_percentile": 32.5, "90th_percentile": 32.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 32.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 32.5, "10th_percentile": 32.5, "90th_percentile": 32.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 32.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 32.5, "10th_percentile": 32.5, "90th_percentile": 32.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 32.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 32.5, "10th_percentile": 32.5, "90th_percentile": 32.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 21.13, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 21.13, "10th_percentile": 21.13, "90th_percentile": 21.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 20.48, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 20.48, "10th_percentile": 20.48, "90th_percentile": 20.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 28.28, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 28.28, "10th_percentile": 28.28, "90th_percentile": 28.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 26.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 26.0, "10th_percentile": 26.0, "90th_percentile": 26.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 21.74, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.74, "10th_percentile": 21.74, "90th_percentile": 21.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 15.76, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15.76, "10th_percentile": 15.76, "90th_percentile": 15.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 16.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 16.25, "10th_percentile": 16.25, "90th_percentile": 16.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 18.99, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.99, "10th_percentile": 18.99, "90th_percentile": 18.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH THE ALLIANCE", "standard_charge_dollar": 17.66, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 17.66, "10th_percentile": 17.66, "90th_percentile": 17.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 15.8, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15.8, "10th_percentile": 15.8, "90th_percentile": 15.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 15.28, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 15.28, "10th_percentile": 15.28, "90th_percentile": 15.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 19.96, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 19.96, "10th_percentile": 19.96, "90th_percentile": 19.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 19.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 19.5, "10th_percentile": 19.5, "90th_percentile": 19.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 19.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 19.5, "10th_percentile": 19.5, "90th_percentile": 19.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 19.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 19.5, "10th_percentile": 19.5, "90th_percentile": 19.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 18.27, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 18.27, "10th_percentile": 18.27, "90th_percentile": 18.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH AETNA", "standard_charge_dollar": 18.27, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 18.27, "10th_percentile": 18.27, "90th_percentile": 18.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 13.65, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 13.65, "10th_percentile": 13.65, "90th_percentile": 13.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 13.65, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 13.65, "10th_percentile": 13.65, "90th_percentile": 13.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 17.71, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 17.71, "10th_percentile": 17.71, "90th_percentile": 17.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 17.71, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 17.71, "10th_percentile": 17.71, "90th_percentile": 17.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 17.71, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 17.71, "10th_percentile": 17.71, "90th_percentile": 17.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 18.17, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 18.17, "10th_percentile": 18.17, "90th_percentile": 18.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 19.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 19.5, "10th_percentile": 19.5, "90th_percentile": 19.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 21.13, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 21.13, "10th_percentile": 21.13, "90th_percentile": 21.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 18.99, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.99, "10th_percentile": 18.99, "90th_percentile": 18.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 19.96, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 19.96, "10th_percentile": 19.96, "90th_percentile": 19.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 19.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 19.5, "10th_percentile": 19.5, "90th_percentile": 19.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 21.13, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 21.13, "10th_percentile": 21.13, "90th_percentile": 21.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $32.50 @ 12.5% = $4.06 due to $0.00 Claim Price", "median_amount": 4.06, "10th_percentile": 4.06, "90th_percentile": 4.06, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $32.50 @ 12.5% = $4.06 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $32.50 @ 12.5% = $4.06 due to $0.00 Claim Price", "median_amount": 4.06, "10th_percentile": 4.06, "90th_percentile": 4.06, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $32.50 @ 12.5% = $4.06 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $32.50 @ 12.5% = $4.06 due to $0.00 Claim Price", "median_amount": 4.06, "10th_percentile": 4.06, "90th_percentile": 4.06, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $32.50 @ 12.5% = $4.06 due to $0.00 Claim Price" } ] } ] }, { "description": "CEFTRIAXONE 2 G INJ SOLR", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-88360", "type": "CDM" }, { "code": "J0696", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "25021-0107-68", "type": "NDC" } ], "standard_charges": [ { "minimum": 12.6, "maximum": 30.0, "setting": "outpatient", "gross_charge": 30.0, "discounted_cash": 21.0, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 30.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 30.0, "10th_percentile": 30.0, "90th_percentile": 30.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 30.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 30.0, "10th_percentile": 30.0, "90th_percentile": 30.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 30.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 30.0, "10th_percentile": 30.0, "90th_percentile": 30.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 30.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 30.0, "10th_percentile": 30.0, "90th_percentile": 30.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 30.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 30.0, "10th_percentile": 30.0, "90th_percentile": 30.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 19.5, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 19.5, "10th_percentile": 19.5, "90th_percentile": 19.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 18.9, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 18.9, "10th_percentile": 18.9, "90th_percentile": 18.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 26.1, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 26.1, "10th_percentile": 26.1, "90th_percentile": 26.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 24.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 24.0, "10th_percentile": 24.0, "90th_percentile": 24.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 20.07, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 14.55, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.55, "10th_percentile": 14.55, "90th_percentile": 14.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 15.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 15.0, "10th_percentile": 15.0, "90th_percentile": 15.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 17.53, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17.53, "10th_percentile": 17.53, "90th_percentile": 17.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH THE ALLIANCE", "standard_charge_dollar": 16.31, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 16.31, "10th_percentile": 16.31, "90th_percentile": 16.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 14.58, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.58, "10th_percentile": 14.58, "90th_percentile": 14.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 14.1, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 14.1, "10th_percentile": 14.1, "90th_percentile": 14.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 18.42, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 18.42, "10th_percentile": 18.42, "90th_percentile": 18.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 18.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 18.0, "10th_percentile": 18.0, "90th_percentile": 18.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 18.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.0, "10th_percentile": 18.0, "90th_percentile": 18.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 18.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 18.0, "10th_percentile": 18.0, "90th_percentile": 18.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 16.86, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 16.86, "10th_percentile": 16.86, "90th_percentile": 16.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH AETNA", "standard_charge_dollar": 16.86, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 16.86, "10th_percentile": 16.86, "90th_percentile": 16.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 12.6, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 12.6, "10th_percentile": 12.6, "90th_percentile": 12.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 12.6, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 12.6, "10th_percentile": 12.6, "90th_percentile": 12.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 16.35, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 16.35, "10th_percentile": 16.35, "90th_percentile": 16.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 16.35, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 16.35, "10th_percentile": 16.35, "90th_percentile": 16.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 16.35, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 16.35, "10th_percentile": 16.35, "90th_percentile": 16.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 16.77, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 16.77, "10th_percentile": 16.77, "90th_percentile": 16.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 18.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 18.0, "10th_percentile": 18.0, "90th_percentile": 18.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 19.5, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 19.5, "10th_percentile": 19.5, "90th_percentile": 19.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 17.53, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17.53, "10th_percentile": 17.53, "90th_percentile": 17.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 18.42, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 18.42, "10th_percentile": 18.42, "90th_percentile": 18.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 18.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 18.0, "10th_percentile": 18.0, "90th_percentile": 18.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 19.5, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 19.5, "10th_percentile": 19.5, "90th_percentile": 19.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $30.00 @ 12.5% = $3.75 due to $0.00 Claim Price", "median_amount": 3.75, "10th_percentile": 3.75, "90th_percentile": 3.75, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $30.00 @ 12.5% = $3.75 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $30.00 @ 12.5% = $3.75 due to $0.00 Claim Price", "median_amount": 3.75, "10th_percentile": 3.75, "90th_percentile": 3.75, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $30.00 @ 12.5% = $3.75 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $30.00 @ 12.5% = $3.75 due to $0.00 Claim Price", "median_amount": 3.75, "10th_percentile": 3.75, "90th_percentile": 3.75, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $30.00 @ 12.5% = $3.75 due to $0.00 Claim Price" } ] } ] }, { "description": "CELLULITIS WITHOUT MCC", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 31046.56, "maximum": 31046.56, "setting": "inpatient", "gross_charge": 58506.24, "discounted_cash": 40954.37, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_percentage": 47.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 27497.94, "10th_percentile": 27497.94, "90th_percentile": 27497.94, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_percentage": 49.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 28668.06, "10th_percentile": 28668.06, "90th_percentile": 28668.06, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Re-evaluated: HLB.779567546; Using historical claim(s); Scope: All Financial Classes; Cases: 4; Inpatient Services; 63% Billed", "median_amount": 36858.94, "10th_percentile": 36858.94, "90th_percentile": 36858.94, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Re-evaluated: HLB.779567546; Using historical claim(s); Scope: All Financial Classes; Cases: 4; Inpatient Services; 54.35% Billed", "median_amount": 31798.15, "10th_percentile": 31798.15, "90th_percentile": 31798.15, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_percentage": 44.0, "standard_charge_algorithm": "Re-evaluated: HLB.779567546; Using historical claim(s); Scope: All Financial Classes; Cases: 4; Inpatient Services; 44% Billed", "median_amount": 25742.75, "10th_percentile": 25742.75, "90th_percentile": 25742.75, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_percentage": 44.0, "standard_charge_algorithm": "Re-evaluated: HLB.779567546; Using historical claim(s); Scope: All Financial Classes; Cases: 4; Inpatient Services; 44% Billed", "median_amount": 25742.75, "10th_percentile": 25742.75, "90th_percentile": 25742.75, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.779567546; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 58506.25, "10th_percentile": 58506.25, "90th_percentile": 58506.25, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.779567546; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 58506.25, "10th_percentile": 58506.25, "90th_percentile": 58506.25, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.779567546; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 58506.25, "10th_percentile": 58506.25, "90th_percentile": 58506.25, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.779567546; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 58506.25, "10th_percentile": 58506.25, "90th_percentile": 58506.25, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.779567546; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 58506.25, "10th_percentile": 58506.25, "90th_percentile": 58506.25, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 31046.56, "standard_charge_algorithm": "Re-evaluated: HLB.779567546; Using historical claim(s); Scope: All Financial Classes; Cases: 4; IP Rehab; FSC: HB MRH & NWR CMG IP REHAB RATES, and; Pricing Extension - HB MRH IP REHAB PPS MEDICARE", "median_amount": 34803.19, "10th_percentile": 34803.19, "90th_percentile": 34803.19, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 31046.56, "standard_charge_algorithm": "Re-evaluated: HLB.779567546; Using historical claim(s); Scope: All Financial Classes; Cases: 4; IP Rehab; FSC: HB MRH & NWR CMG IP REHAB RATES, and; Pricing Extension - HB MRH IP REHAB PPS MEDICARE", "median_amount": 34803.19, "10th_percentile": 34803.19, "90th_percentile": 34803.19, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_dollar": 31046.56, "standard_charge_algorithm": "Re-evaluated: HLB.779567546; Using historical claim(s); Scope: All Financial Classes; Cases: 4; IP Rehab; FSC: HB MRH & NWR CMG IP REHAB RATES, and; Pricing Extension - HB MRH IP REHAB PPS MEDICARE", "median_amount": 34803.19, "10th_percentile": 34803.19, "90th_percentile": 34803.19, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_dollar": 31046.56, "standard_charge_algorithm": "Re-evaluated: HLB.779567546; Using historical claim(s); Scope: All Financial Classes; Cases: 4; IP Rehab; FSC: HB MRH & NWR CMG IP REHAB RATES, and; Pricing Extension - HB MRH IP REHAB PPS MEDICARE", "median_amount": 34803.19, "10th_percentile": 34803.19, "90th_percentile": 34803.19, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_dollar": 31046.56, "standard_charge_algorithm": "Re-evaluated: HLB.779567546; Using historical claim(s); Scope: All Financial Classes; Cases: 4; IP Rehab; FSC: HB MRH & NWR CMG IP REHAB RATES, and; Pricing Extension - HB MRH IP REHAB PPS MEDICARE", "median_amount": 34803.19, "10th_percentile": 34803.19, "90th_percentile": 34803.19, "count": "1 through 10", "methodology": "case rate" } ] } ] }, { "description": "CEPHALEXIN 250 MG ORAL CAP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-9499", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "60687-0152-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "CEPHALEXIN 250 MG ORAL CAP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-9499", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "60687-0152-11", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "CEPHALEXIN 500 MG ORAL CAP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-9500", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "50268-0152-15", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "CHOLECALCIFEROL (VITAMIN D3) 25 MCG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-82640", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "20555-0033-00", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.42, "maximum": 1.0, "setting": "outpatient", "gross_charge": 1.0, "discounted_cash": 0.7, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 0.56, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 0.56, "10th_percentile": 0.56, "90th_percentile": 0.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 0.51, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 0.51, "10th_percentile": 0.51, "90th_percentile": 0.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 0.54, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 0.8, "10th_percentile": 0.8, "90th_percentile": 0.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 0.63, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 0.87, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 0.87, "10th_percentile": 0.87, "90th_percentile": 0.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 0.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.47, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 0.47, "10th_percentile": 0.47, "90th_percentile": 0.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 0.67, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.67, "10th_percentile": 0.67, "90th_percentile": 0.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CHOLECALCIFEROL (VITAMIN D3) 125 MCG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-179331", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "79854-0079-41", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.42, "maximum": 1.0, "setting": "outpatient", "gross_charge": 1.0, "discounted_cash": 0.7, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 0.56, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 0.56, "10th_percentile": 0.56, "90th_percentile": 0.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 0.51, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 0.51, "10th_percentile": 0.51, "90th_percentile": 0.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 0.54, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 0.8, "10th_percentile": 0.8, "90th_percentile": 0.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 0.63, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 0.87, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 0.87, "10th_percentile": 0.87, "90th_percentile": 0.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 0.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.47, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 0.47, "10th_percentile": 0.47, "90th_percentile": 0.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 0.67, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.67, "10th_percentile": 0.67, "90th_percentile": 0.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CILOSTAZOL 100 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-24474", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00093-2064-06", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "CINACALCET 30 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-96785", "type": "CDM" }, { "code": "25000000", "type": "LOCAL" }, { "code": "0250", "type": "RC" }, { "code": "16729-0440-15", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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" } ] } ] }, { "description": "CIPROFLOXACIN HCL 0.3 % OPHT DROP", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "RX-9610", "type": "CDM" }, { "code": "25000000", "type": "LOCAL" }, { "code": "0250", "type": "RC" }, { "code": "69315-0308-05", "type": "NDC" } ], "standard_charges": [ { "minimum": 79.59, "maximum": 189.5, "setting": "outpatient", "gross_charge": 189.5, "discounted_cash": 132.65, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 189.5, "10th_percentile": 189.5, "90th_percentile": 189.5, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 189.5, "10th_percentile": 189.5, "90th_percentile": 189.5, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 189.5, "10th_percentile": 189.5, "90th_percentile": 189.5, "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": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 96.57, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 96.57, "10th_percentile": 96.57, "90th_percentile": 96.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 91.96, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 91.96, "10th_percentile": 91.96, "90th_percentile": 91.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 91.96, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 91.96, "10th_percentile": 91.96, "90th_percentile": 91.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 110.74, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 110.74, "10th_percentile": 110.74, "90th_percentile": 110.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 105.93, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 105.93, "10th_percentile": 105.93, "90th_percentile": 105.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 109.3, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 109.3, "10th_percentile": 109.3, "90th_percentile": 109.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 113.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 113.7, "10th_percentile": 113.7, "90th_percentile": 113.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 123.18, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 123.18, "10th_percentile": 123.18, "90th_percentile": 123.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 123.18, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 123.18, "10th_percentile": 123.18, "90th_percentile": 123.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 113.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 113.7, "10th_percentile": 113.7, "90th_percentile": 113.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 89.07, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 89.07, "10th_percentile": 89.07, "90th_percentile": 89.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 79.59, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 79.59, "10th_percentile": 79.59, "90th_percentile": 79.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 110.74, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 110.74, "10th_percentile": 110.74, "90th_percentile": 110.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 109.3, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 109.3, "10th_percentile": 109.3, "90th_percentile": 109.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 94.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 94.75, "10th_percentile": 94.75, "90th_percentile": 94.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 113.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 113.7, "10th_percentile": 113.7, "90th_percentile": 113.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 126.78, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 126.78, "10th_percentile": 126.78, "90th_percentile": 126.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 164.87, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 164.87, "10th_percentile": 164.87, "90th_percentile": 164.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 119.39, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 119.39, "10th_percentile": 119.39, "90th_percentile": 119.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 113.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 113.7, "10th_percentile": 113.7, "90th_percentile": 113.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 123.18, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 123.18, "10th_percentile": 123.18, "90th_percentile": 123.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 113.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 113.7, "10th_percentile": 113.7, "90th_percentile": 113.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 79.59, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 79.59, "10th_percentile": 79.59, "90th_percentile": 79.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 151.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 151.6, "10th_percentile": 151.6, "90th_percentile": 151.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 102.99, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 102.99, "10th_percentile": 102.99, "90th_percentile": 102.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 92.1, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 92.1, "10th_percentile": 92.1, "90th_percentile": 92.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 91.91, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 91.91, "10th_percentile": 91.91, "90th_percentile": 91.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 189.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 189.5, "10th_percentile": 189.5, "90th_percentile": 189.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 189.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 189.5, "10th_percentile": 189.5, "90th_percentile": 189.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 189.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 189.5, "10th_percentile": 189.5, "90th_percentile": 189.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 189.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 189.5, "10th_percentile": 189.5, "90th_percentile": 189.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 189.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 189.5, "10th_percentile": 189.5, "90th_percentile": 189.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "CIPROFLOXACIN HCL 500 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-25119", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "65862-0077-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 4.0, "10th_percentile": 4.0, "90th_percentile": 4.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4.00 @ 12.5% = $0.50 due to $0.00 Claim Price", "median_amount": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4.00 @ 12.5% = $0.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4.00 @ 12.5% = $0.50 due to $0.00 Claim Price", "median_amount": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4.00 @ 12.5% = $0.50 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4.00 @ 12.5% = $0.50 due to $0.00 Claim Price", "median_amount": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4.00 @ 12.5% = $0.50 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.18, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2.18, "10th_percentile": 2.18, "90th_percentile": 2.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2.18, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2.18, "10th_percentile": 2.18, "90th_percentile": 2.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2.18, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2.18, "10th_percentile": 2.18, "90th_percentile": 2.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.46, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 2.46, "10th_percentile": 2.46, "90th_percentile": 2.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.46, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 2.46, "10th_percentile": 2.46, "90th_percentile": 2.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "CITALOPRAM 20 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-21062", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00904-6085-61", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "CLOBAZAM 2.5 MG/ML ORAL SUSP", "drug_information": { "unit": 120.0, "type": "ML" }, "code_information": [ { "code": "RX-197370", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "69452-0116-45", "type": "NDC" } ], "standard_charges": [ { "minimum": 766.92, "maximum": 1826.0, "setting": "outpatient", "gross_charge": 1826.0, "discounted_cash": 1278.2, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 886.16, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 886.16, "10th_percentile": 886.16, "90th_percentile": 886.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 886.16, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 886.16, "10th_percentile": 886.16, "90th_percentile": 886.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 1095.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1095.6, "10th_percentile": 1095.6, "90th_percentile": 1095.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1020.73, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 1020.73, "10th_percentile": 1020.73, "90th_percentile": 1020.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1067.11, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1067.11, "10th_percentile": 1067.11, "90th_percentile": 1067.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 1053.24, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 1053.24, "10th_percentile": 1053.24, "90th_percentile": 1053.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 930.53, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 930.53, "10th_percentile": 930.53, "90th_percentile": 930.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 1186.9, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 1186.9, "10th_percentile": 1186.9, "90th_percentile": 1186.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 1186.9, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1095.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 913.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 913.0, "10th_percentile": 913.0, "90th_percentile": 913.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH UHC CORE", "standard_charge_dollar": 885.61, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 885.61, "10th_percentile": 885.61, "90th_percentile": 885.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 1150.38, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 1150.38, "10th_percentile": 1150.38, "90th_percentile": 1150.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 858.22, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 858.22, "10th_percentile": 858.22, "90th_percentile": 858.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1067.11, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1067.11, "10th_percentile": 1067.11, "90th_percentile": 1067.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 1053.24, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 1053.24, "10th_percentile": 1053.24, "90th_percentile": 1053.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 1588.62, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 1588.62, "10th_percentile": 1588.62, "90th_percentile": 1588.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 1221.59, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1221.59, "10th_percentile": 1221.59, "90th_percentile": 1221.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 1186.9, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 1186.9, "10th_percentile": 1186.9, "90th_percentile": 1186.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 992.43, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 992.43, "10th_percentile": 992.43, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 1460.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 1460.8, "10th_percentile": 1460.8, "90th_percentile": 1460.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 887.44, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 887.44, "10th_percentile": 887.44, "90th_percentile": 887.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1095.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 1095.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1095.6, "10th_percentile": 1095.6, "90th_percentile": 1095.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 1095.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1095.6, "10th_percentile": 1095.6, "90th_percentile": 1095.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 766.92, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 766.92, "10th_percentile": 766.92, "90th_percentile": 766.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 766.92, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 766.92, "10th_percentile": 766.92, "90th_percentile": 766.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1826.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1826.0, "10th_percentile": 1826.0, "90th_percentile": 1826.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1826.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1826.0, "10th_percentile": 1826.0, "90th_percentile": 1826.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1826.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1826.0, "10th_percentile": 1826.0, "90th_percentile": 1826.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1826.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1826.0, "10th_percentile": 1826.0, "90th_percentile": 1826.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1826.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1826.0, "10th_percentile": 1826.0, "90th_percentile": 1826.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1826.0, "10th_percentile": 1826.0, "90th_percentile": 1826.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1826.0, "10th_percentile": 1826.0, "90th_percentile": 1826.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1826.0, "10th_percentile": 1826.0, "90th_percentile": 1826.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CLONAZEPAM 0.5 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-9637", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "16729-0136-00", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "CLONIDINE HCL 0.05 MG ORAL HALF TAB", "drug_information": { "unit": 0.05, "type": "ME" }, "code_information": [ { "code": "RX-4080000020", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00000-0100-20", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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" } ] } ] }, { "description": "CLONIDINE HCL 0.1 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-1755", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "60687-0113-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "CLONIDINE HCL 0.2 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-1756", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "68001-0238-00", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "COLCHICINE 0.1 MG/ML ORAL SUSP (COMPOUND)", "drug_information": { "unit": 6.0, "type": "ML" }, "code_information": [ { "code": "RX-221308", "type": "CDM" }, { "code": "25000000", "type": "LOCAL" }, { "code": "0250", "type": "RC" }, { "code": "99991-0027-44", "type": "NDC" } ], "standard_charges": [ { "minimum": 42.84, "maximum": 102.0, "setting": "outpatient", "gross_charge": 102.0, "discounted_cash": 71.4, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "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": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 49.5, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 49.5, "10th_percentile": 49.5, "90th_percentile": 49.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 49.5, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 49.5, "10th_percentile": 49.5, "90th_percentile": 49.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 66.3, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 66.3, "10th_percentile": 66.3, "90th_percentile": 66.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 61.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 61.2, "10th_percentile": 61.2, "90th_percentile": 61.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 58.83, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 58.83, "10th_percentile": 58.83, "90th_percentile": 58.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 51.98, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 51.98, "10th_percentile": 51.98, "90th_percentile": 51.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 59.61, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.61, "10th_percentile": 59.61, "90th_percentile": 59.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 57.02, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 57.02, "10th_percentile": 57.02, "90th_percentile": 57.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 61.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 61.2, "10th_percentile": 61.2, "90th_percentile": 61.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 66.3, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 66.3, "10th_percentile": 66.3, "90th_percentile": 66.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 47.94, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 47.94, "10th_percentile": 47.94, "90th_percentile": 47.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 59.61, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.61, "10th_percentile": 59.61, "90th_percentile": 59.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 58.83, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 58.83, "10th_percentile": 58.83, "90th_percentile": 58.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 51.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 51.0, "10th_percentile": 51.0, "90th_percentile": 51.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 68.24, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.24, "10th_percentile": 68.24, "90th_percentile": 68.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 88.74, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 88.74, "10th_percentile": 88.74, "90th_percentile": 88.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 64.26, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 64.26, "10th_percentile": 64.26, "90th_percentile": 64.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 66.3, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 66.3, "10th_percentile": 66.3, "90th_percentile": 66.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 81.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 81.6, "10th_percentile": 81.6, "90th_percentile": 81.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 55.44, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 55.44, "10th_percentile": 55.44, "90th_percentile": 55.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 49.57, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.57, "10th_percentile": 49.57, "90th_percentile": 49.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 49.47, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.47, "10th_percentile": 49.47, "90th_percentile": 49.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 61.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 61.2, "10th_percentile": 61.2, "90th_percentile": 61.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 61.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 61.2, "10th_percentile": 61.2, "90th_percentile": 61.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 61.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 61.2, "10th_percentile": 61.2, "90th_percentile": 61.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 42.84, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 42.84, "10th_percentile": 42.84, "90th_percentile": 42.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 42.84, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 42.84, "10th_percentile": 42.84, "90th_percentile": 42.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "COMPOUND VEH SF (ORA-PLUS) NO.20 ORAL SUSP", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "RX-206842", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00574-0303-16", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.42, "maximum": 1.0, "setting": "outpatient", "gross_charge": 1.0, "discounted_cash": 0.7, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.47, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 0.47, "10th_percentile": 0.47, "90th_percentile": 0.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 0.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 0.67, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.67, "10th_percentile": 0.67, "90th_percentile": 0.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 0.87, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 0.87, "10th_percentile": 0.87, "90th_percentile": 0.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 0.63, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 0.8, "10th_percentile": 0.8, "90th_percentile": 0.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 0.54, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 0.51, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 0.51, "10th_percentile": 0.51, "90th_percentile": 0.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 0.56, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 0.56, "10th_percentile": 0.56, "90th_percentile": 0.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" } ] } ] }, { "description": "COMPOUND VEH SF (ORA-PLUS) NO.20 ORAL SUSP", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "RX-206842", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "38779-0743-08", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.42, "maximum": 1.0, "setting": "outpatient", "gross_charge": 1.0, "discounted_cash": 0.7, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 0.51, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 0.51, "10th_percentile": 0.51, "90th_percentile": 0.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 0.56, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 0.56, "10th_percentile": 0.56, "90th_percentile": 0.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.47, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 0.47, "10th_percentile": 0.47, "90th_percentile": 0.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 0.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 0.67, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.67, "10th_percentile": 0.67, "90th_percentile": 0.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 0.87, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 0.87, "10th_percentile": 0.87, "90th_percentile": 0.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 0.63, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 0.8, "10th_percentile": 0.8, "90th_percentile": 0.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 0.54, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "COMPOUND VEH SF (ORA-SWEET-SF) NO.9 ORAL LIQD", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "RX-179579", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00574-0302-16", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.42, "maximum": 1.0, "setting": "outpatient", "gross_charge": 1.0, "discounted_cash": 0.7, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 0.51, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 0.51, "10th_percentile": 0.51, "90th_percentile": 0.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 0.56, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 0.56, "10th_percentile": 0.56, "90th_percentile": 0.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.47, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 0.47, "10th_percentile": 0.47, "90th_percentile": 0.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 0.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 0.67, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.67, "10th_percentile": 0.67, "90th_percentile": 0.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 0.87, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 0.87, "10th_percentile": 0.87, "90th_percentile": 0.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 0.63, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 0.8, "10th_percentile": 0.8, "90th_percentile": 0.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 0.54, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "COVID VAC 25-26(6M-11Y)(MOD)PF 25 MCG/0.25 ML IM SYRG", "drug_information": { "unit": 0.25, "type": "ML" }, "code_information": [ { "code": "RX-251279", "type": "CDM" }, { "code": "91321", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "80777-0113-09", "type": "NDC" } ], "standard_charges": [ { "minimum": 41.58, "maximum": 99.0, "setting": "outpatient", "gross_charge": 99.0, "discounted_cash": 69.3, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 99.0, "10th_percentile": 99.0, "90th_percentile": 99.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 99.0, "10th_percentile": 99.0, "90th_percentile": 99.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 99.0, "10th_percentile": 99.0, "90th_percentile": 99.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 99.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 99.0, "10th_percentile": 99.0, "90th_percentile": 99.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 99.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 99.0, "10th_percentile": 99.0, "90th_percentile": 99.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 99.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 99.0, "10th_percentile": 99.0, "90th_percentile": 99.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 99.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 99.0, "10th_percentile": 99.0, "90th_percentile": 99.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 99.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 99.0, "10th_percentile": 99.0, "90th_percentile": 99.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 55.64, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 55.64, "10th_percentile": 55.64, "90th_percentile": 55.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH AETNA", "standard_charge_dollar": 55.64, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 55.64, "10th_percentile": 55.64, "90th_percentile": 55.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 59.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 59.4, "10th_percentile": 59.4, "90th_percentile": 59.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 59.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 59.4, "10th_percentile": 59.4, "90th_percentile": 59.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 59.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.4, "10th_percentile": 59.4, "90th_percentile": 59.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 66.23, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 66.23, "10th_percentile": 66.23, "90th_percentile": 66.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 48.02, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 48.02, "10th_percentile": 48.02, "90th_percentile": 48.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS HMO", "standard_charge_dollar": 57.86, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.86, "10th_percentile": 57.86, "90th_percentile": 57.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 48.11, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 48.11, "10th_percentile": 48.11, "90th_percentile": 48.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH PHCS", "standard_charge_dollar": 79.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 79.2, "10th_percentile": 79.2, "90th_percentile": 79.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 49.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 49.5, "10th_percentile": 49.5, "90th_percentile": 49.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 62.37, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 62.37, "10th_percentile": 62.37, "90th_percentile": 62.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 53.81, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 53.81, "10th_percentile": 53.81, "90th_percentile": 53.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 86.13, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 86.13, "10th_percentile": 86.13, "90th_percentile": 86.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 64.35, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 64.35, "10th_percentile": 64.35, "90th_percentile": 64.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 46.53, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 46.53, "10th_percentile": 46.53, "90th_percentile": 46.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 57.1, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 57.1, "10th_percentile": 57.1, "90th_percentile": 57.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 41.58, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 41.58, "10th_percentile": 41.58, "90th_percentile": 41.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 41.58, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 41.58, "10th_percentile": 41.58, "90th_percentile": 41.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 55.34, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 55.34, "10th_percentile": 55.34, "90th_percentile": 55.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 57.86, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.86, "10th_percentile": 57.86, "90th_percentile": 57.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 64.35, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 64.35, "10th_percentile": 64.35, "90th_percentile": 64.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 59.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 59.4, "10th_percentile": 59.4, "90th_percentile": 59.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 59.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 59.4, "10th_percentile": 59.4, "90th_percentile": 59.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 64.35, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 64.35, "10th_percentile": 64.35, "90th_percentile": 64.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 48.04, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 48.04, "10th_percentile": 48.04, "90th_percentile": 48.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 48.04, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 48.04, "10th_percentile": 48.04, "90th_percentile": 48.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 50.45, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 50.45, "10th_percentile": 50.45, "90th_percentile": 50.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 57.1, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 57.1, "10th_percentile": 57.1, "90th_percentile": 57.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." } ] } ] }, { "description": "COVID VAC 25-26(6M-11Y)(MOD)PF 25 MCG/0.25 ML IM SYRG", "drug_information": { "unit": 0.25, "type": "ML" }, "code_information": [ { "code": "RX-251279", "type": "CDM" }, { "code": "91321", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "80777-0113-80", "type": "NDC" } ], "standard_charges": [ { "minimum": 41.58, "maximum": 99.0, "setting": "outpatient", "gross_charge": 99.0, "discounted_cash": 69.3, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 99.0, "10th_percentile": 99.0, "90th_percentile": 99.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 99.0, "10th_percentile": 99.0, "90th_percentile": 99.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 99.0, "10th_percentile": 99.0, "90th_percentile": 99.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 99.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 99.0, "10th_percentile": 99.0, "90th_percentile": 99.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 99.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 99.0, "10th_percentile": 99.0, "90th_percentile": 99.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 99.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 99.0, "10th_percentile": 99.0, "90th_percentile": 99.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 99.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 99.0, "10th_percentile": 99.0, "90th_percentile": 99.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 99.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 99.0, "10th_percentile": 99.0, "90th_percentile": 99.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 55.64, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 55.64, "10th_percentile": 55.64, "90th_percentile": 55.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH AETNA", "standard_charge_dollar": 55.64, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 55.64, "10th_percentile": 55.64, "90th_percentile": 55.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 59.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 59.4, "10th_percentile": 59.4, "90th_percentile": 59.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 59.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 59.4, "10th_percentile": 59.4, "90th_percentile": 59.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 59.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.4, "10th_percentile": 59.4, "90th_percentile": 59.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 66.23, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 66.23, "10th_percentile": 66.23, "90th_percentile": 66.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 48.02, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 48.02, "10th_percentile": 48.02, "90th_percentile": 48.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS HMO", "standard_charge_dollar": 57.86, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.86, "10th_percentile": 57.86, "90th_percentile": 57.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 48.11, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 48.11, "10th_percentile": 48.11, "90th_percentile": 48.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH PHCS", "standard_charge_dollar": 79.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 79.2, "10th_percentile": 79.2, "90th_percentile": 79.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 49.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 49.5, "10th_percentile": 49.5, "90th_percentile": 49.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 62.37, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 62.37, "10th_percentile": 62.37, "90th_percentile": 62.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 53.81, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 53.81, "10th_percentile": 53.81, "90th_percentile": 53.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 86.13, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 86.13, "10th_percentile": 86.13, "90th_percentile": 86.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 64.35, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 64.35, "10th_percentile": 64.35, "90th_percentile": 64.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 46.53, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 46.53, "10th_percentile": 46.53, "90th_percentile": 46.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 57.1, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 57.1, "10th_percentile": 57.1, "90th_percentile": 57.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 41.58, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 41.58, "10th_percentile": 41.58, "90th_percentile": 41.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 41.58, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 41.58, "10th_percentile": 41.58, "90th_percentile": 41.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 55.34, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 55.34, "10th_percentile": 55.34, "90th_percentile": 55.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 57.86, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.86, "10th_percentile": 57.86, "90th_percentile": 57.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 64.35, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 64.35, "10th_percentile": 64.35, "90th_percentile": 64.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 59.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 59.4, "10th_percentile": 59.4, "90th_percentile": 59.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 59.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 59.4, "10th_percentile": 59.4, "90th_percentile": 59.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 64.35, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 64.35, "10th_percentile": 64.35, "90th_percentile": 64.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 48.04, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 48.04, "10th_percentile": 48.04, "90th_percentile": 48.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 48.04, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 48.04, "10th_percentile": 48.04, "90th_percentile": 48.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 50.45, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 50.45, "10th_percentile": 50.45, "90th_percentile": 50.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 57.1, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 57.1, "10th_percentile": 57.1, "90th_percentile": 57.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." } ] } ] }, { "description": "CYANOCOBALAMIN (VITAMIN B-12) 250 MCG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-85286", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "50268-0853-15", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.42, "maximum": 1.0, "setting": "outpatient", "gross_charge": 1.0, "discounted_cash": 0.7, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 0.56, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 0.56, "10th_percentile": 0.56, "90th_percentile": 0.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 0.51, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 0.51, "10th_percentile": 0.51, "90th_percentile": 0.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 0.54, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 0.8, "10th_percentile": 0.8, "90th_percentile": 0.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 0.63, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 0.87, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 0.87, "10th_percentile": 0.87, "90th_percentile": 0.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 0.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.47, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 0.47, "10th_percentile": 0.47, "90th_percentile": 0.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 0.67, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.67, "10th_percentile": 0.67, "90th_percentile": 0.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "DANTROLENE 50 MG ORAL CAP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-9719", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00115-4422-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 7.46, "maximum": 17.75, "setting": "outpatient", "gross_charge": 17.75, "discounted_cash": 12.42, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 11.54, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 11.54, "10th_percentile": 11.54, "90th_percentile": 11.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 10.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 10.65, "10th_percentile": 10.65, "90th_percentile": 10.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 9.92, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 9.92, "10th_percentile": 9.92, "90th_percentile": 9.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 10.37, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.37, "10th_percentile": 10.37, "90th_percentile": 10.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 10.24, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 10.24, "10th_percentile": 10.24, "90th_percentile": 10.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 11.54, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 11.54, "10th_percentile": 11.54, "90th_percentile": 11.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 9.05, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 9.05, "10th_percentile": 9.05, "90th_percentile": 9.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 10.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 10.65, "10th_percentile": 10.65, "90th_percentile": 10.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 8.61, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 8.61, "10th_percentile": 8.61, "90th_percentile": 8.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 8.61, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 8.61, "10th_percentile": 8.61, "90th_percentile": 8.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 8.34, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 8.34, "10th_percentile": 8.34, "90th_percentile": 8.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 10.37, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.37, "10th_percentile": 10.37, "90th_percentile": 10.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 10.24, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 10.24, "10th_percentile": 10.24, "90th_percentile": 10.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 8.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 8.88, "10th_percentile": 8.88, "90th_percentile": 8.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 11.87, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.87, "10th_percentile": 11.87, "90th_percentile": 11.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 15.44, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 15.44, "10th_percentile": 15.44, "90th_percentile": 15.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 11.18, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 11.18, "10th_percentile": 11.18, "90th_percentile": 11.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 11.54, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 11.54, "10th_percentile": 11.54, "90th_percentile": 11.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 14.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 14.2, "10th_percentile": 14.2, "90th_percentile": 14.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 9.65, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 9.65, "10th_percentile": 9.65, "90th_percentile": 9.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 8.63, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 8.61, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.61, "10th_percentile": 8.61, "90th_percentile": 8.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 10.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 10.65, "10th_percentile": 10.65, "90th_percentile": 10.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 10.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.65, "10th_percentile": 10.65, "90th_percentile": 10.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 10.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 10.65, "10th_percentile": 10.65, "90th_percentile": 10.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 7.46, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 7.46, "10th_percentile": 7.46, "90th_percentile": 7.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 7.46, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 7.46, "10th_percentile": 7.46, "90th_percentile": 7.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 17.75, "10th_percentile": 17.75, "90th_percentile": 17.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 17.75, "10th_percentile": 17.75, "90th_percentile": 17.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 17.75, "10th_percentile": 17.75, "90th_percentile": 17.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 17.75, "10th_percentile": 17.75, "90th_percentile": 17.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 17.75, "10th_percentile": 17.75, "90th_percentile": 17.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 17.75, "10th_percentile": 17.75, "90th_percentile": 17.75, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 17.75, "10th_percentile": 17.75, "90th_percentile": 17.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 17.75, "10th_percentile": 17.75, "90th_percentile": 17.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "DEMECLOCYCLINE 300 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-9727", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "42806-0144-48", "type": "NDC" } ], "standard_charges": [ { "minimum": 38.12, "maximum": 90.75, "setting": "outpatient", "gross_charge": 90.75, "discounted_cash": 63.52, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 58.99, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 58.99, "10th_percentile": 58.99, "90th_percentile": 58.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 54.45, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 54.45, "10th_percentile": 54.45, "90th_percentile": 54.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 50.73, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 50.73, "10th_percentile": 50.73, "90th_percentile": 50.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 53.03, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 52.34, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 52.34, "10th_percentile": 52.34, "90th_percentile": 52.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 58.99, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 58.99, "10th_percentile": 58.99, "90th_percentile": 58.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 46.25, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 46.25, "10th_percentile": 46.25, "90th_percentile": 46.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 54.45, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 54.45, "10th_percentile": 54.45, "90th_percentile": 54.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 44.04, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 44.04, "10th_percentile": 44.04, "90th_percentile": 44.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 44.04, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 44.04, "10th_percentile": 44.04, "90th_percentile": 44.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 42.65, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 42.65, "10th_percentile": 42.65, "90th_percentile": 42.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 53.03, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 52.34, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 52.34, "10th_percentile": 52.34, "90th_percentile": 52.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 45.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 45.38, "10th_percentile": 45.38, "90th_percentile": 45.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 60.71, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 60.71, "10th_percentile": 60.71, "90th_percentile": 60.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 78.95, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 78.95, "10th_percentile": 78.95, "90th_percentile": 78.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 57.17, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 57.17, "10th_percentile": 57.17, "90th_percentile": 57.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 58.99, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 58.99, "10th_percentile": 58.99, "90th_percentile": 58.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 72.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 72.6, "10th_percentile": 72.6, "90th_percentile": 72.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 49.32, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 49.32, "10th_percentile": 49.32, "90th_percentile": 49.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 44.1, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.1, "10th_percentile": 44.1, "90th_percentile": 44.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 44.01, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.01, "10th_percentile": 44.01, "90th_percentile": 44.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 54.45, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 54.45, "10th_percentile": 54.45, "90th_percentile": 54.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 54.45, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 54.45, "10th_percentile": 54.45, "90th_percentile": 54.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 54.45, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 54.45, "10th_percentile": 54.45, "90th_percentile": 54.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 38.12, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 38.12, "10th_percentile": 38.12, "90th_percentile": 38.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 38.12, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 38.12, "10th_percentile": 38.12, "90th_percentile": 38.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 90.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.75, "10th_percentile": 90.75, "90th_percentile": 90.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 90.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.75, "10th_percentile": 90.75, "90th_percentile": 90.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 90.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.75, "10th_percentile": 90.75, "90th_percentile": 90.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 90.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.75, "10th_percentile": 90.75, "90th_percentile": 90.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 90.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.75, "10th_percentile": 90.75, "90th_percentile": 90.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.75, "10th_percentile": 90.75, "90th_percentile": 90.75, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.75, "10th_percentile": 90.75, "90th_percentile": 90.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.75, "10th_percentile": 90.75, "90th_percentile": 90.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "DESMOPRESSIN 0.05 MG ORAL HALF TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-224867", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "99991-0036-10", "type": "NDC" } ], "standard_charges": [ { "minimum": 3.99, "maximum": 9.5, "setting": "outpatient", "gross_charge": 9.5, "discounted_cash": 6.65, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 6.18, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 6.18, "10th_percentile": 6.18, "90th_percentile": 6.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 5.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 5.7, "10th_percentile": 5.7, "90th_percentile": 5.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 5.31, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 5.31, "10th_percentile": 5.31, "90th_percentile": 5.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 5.55, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.55, "10th_percentile": 5.55, "90th_percentile": 5.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 5.48, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% 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; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 6.18, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 6.18, "10th_percentile": 6.18, "90th_percentile": 6.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 4.84, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% 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; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 5.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 5.7, "10th_percentile": 5.7, "90th_percentile": 5.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 4.61, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% 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; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 4.61, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% 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; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 4.47, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 4.47, "10th_percentile": 4.47, "90th_percentile": 4.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 5.55, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.55, "10th_percentile": 5.55, "90th_percentile": 5.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 5.48, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% 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; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 4.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 4.75, "10th_percentile": 4.75, "90th_percentile": 4.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 6.36, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.36, "10th_percentile": 6.36, "90th_percentile": 6.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 8.27, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 8.27, "10th_percentile": 8.27, "90th_percentile": 8.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 5.99, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 5.99, "10th_percentile": 5.99, "90th_percentile": 5.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 6.18, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 6.18, "10th_percentile": 6.18, "90th_percentile": 6.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 7.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 7.6, "10th_percentile": 7.6, "90th_percentile": 7.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 5.16, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 5.16, "10th_percentile": 5.16, "90th_percentile": 5.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 4.62, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 4.61, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.61, "10th_percentile": 4.61, "90th_percentile": 4.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 5.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 5.7, "10th_percentile": 5.7, "90th_percentile": 5.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 5.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.7, "10th_percentile": 5.7, "90th_percentile": 5.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 5.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 5.7, "10th_percentile": 5.7, "90th_percentile": 5.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 3.99, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 3.99, "10th_percentile": 3.99, "90th_percentile": 3.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 3.99, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 3.99, "10th_percentile": 3.99, "90th_percentile": 3.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9.5, "10th_percentile": 9.5, "90th_percentile": 9.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9.5, "10th_percentile": 9.5, "90th_percentile": 9.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9.5, "10th_percentile": 9.5, "90th_percentile": 9.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9.5, "10th_percentile": 9.5, "90th_percentile": 9.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9.5, "10th_percentile": 9.5, "90th_percentile": 9.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 9.5, "10th_percentile": 9.5, "90th_percentile": 9.5, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 9.5, "10th_percentile": 9.5, "90th_percentile": 9.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 9.5, "10th_percentile": 9.5, "90th_percentile": 9.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "DESMOPRESSIN 0.1 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-16052", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "69918-0101-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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" } ] } ] }, { "description": "DESOXIMETASONE 0.25 % TOP OINT", "drug_information": { "unit": 15.0, "type": "GR" }, "code_information": [ { "code": "RX-9753", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "51672-1262-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 75.08, "maximum": 178.75, "setting": "outpatient", "gross_charge": 178.75, "discounted_cash": 125.12, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 75.08, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 75.08, "10th_percentile": 75.08, "90th_percentile": 75.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 75.08, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 75.08, "10th_percentile": 75.08, "90th_percentile": 75.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 84.01, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 84.01, "10th_percentile": 84.01, "90th_percentile": 84.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 104.46, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 104.46, "10th_percentile": 104.46, "90th_percentile": 104.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 103.1, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 103.1, "10th_percentile": 103.1, "90th_percentile": 103.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 89.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 89.38, "10th_percentile": 89.38, "90th_percentile": 89.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 107.25, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 107.25, "10th_percentile": 107.25, "90th_percentile": 107.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 119.58, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 119.58, "10th_percentile": 119.58, "90th_percentile": 119.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 155.51, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 155.51, "10th_percentile": 155.51, "90th_percentile": 155.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 112.61, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 112.61, "10th_percentile": 112.61, "90th_percentile": 112.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 107.25, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 107.25, "10th_percentile": 107.25, "90th_percentile": 107.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 116.19, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 116.19, "10th_percentile": 116.19, "90th_percentile": 116.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 107.25, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 107.25, "10th_percentile": 107.25, "90th_percentile": 107.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 143.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 143.0, "10th_percentile": 143.0, "90th_percentile": 143.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 97.15, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 97.15, "10th_percentile": 97.15, "90th_percentile": 97.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 86.87, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 86.87, "10th_percentile": 86.87, "90th_percentile": 86.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 86.69, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 86.69, "10th_percentile": 86.69, "90th_percentile": 86.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 107.25, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 107.25, "10th_percentile": 107.25, "90th_percentile": 107.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 116.19, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 116.19, "10th_percentile": 116.19, "90th_percentile": 116.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 116.19, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 116.19, "10th_percentile": 116.19, "90th_percentile": 116.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 107.25, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 107.25, "10th_percentile": 107.25, "90th_percentile": 107.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 104.46, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 104.46, "10th_percentile": 104.46, "90th_percentile": 104.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 103.1, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 103.1, "10th_percentile": 103.1, "90th_percentile": 103.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 91.09, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 91.09, "10th_percentile": 91.09, "90th_percentile": 91.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 99.92, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 99.92, "10th_percentile": 99.92, "90th_percentile": 99.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 86.75, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 86.75, "10th_percentile": 86.75, "90th_percentile": 86.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 86.75, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 86.75, "10th_percentile": 86.75, "90th_percentile": 86.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 178.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 178.75, "10th_percentile": 178.75, "90th_percentile": 178.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 178.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 178.75, "10th_percentile": 178.75, "90th_percentile": 178.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 178.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 178.75, "10th_percentile": 178.75, "90th_percentile": 178.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 178.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 178.75, "10th_percentile": 178.75, "90th_percentile": 178.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 178.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 178.75, "10th_percentile": 178.75, "90th_percentile": 178.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 178.75, "10th_percentile": 178.75, "90th_percentile": 178.75, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 178.75, "10th_percentile": 178.75, "90th_percentile": 178.75, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 178.75, "10th_percentile": 178.75, "90th_percentile": 178.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "RX-100784", "type": "CDM" }, { "code": "J1100", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "63323-0506-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 8.4, "maximum": 20.0, "setting": "outpatient", "gross_charge": 20.0, "discounted_cash": 14.0, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 10.9, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "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 OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 10.9, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "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 OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 10.9, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "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 OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 11.69, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.69, "10th_percentile": 11.69, "90th_percentile": 11.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 11.18, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 11.18, "10th_percentile": 11.18, "90th_percentile": 11.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 12.28, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 12.28, "10th_percentile": 12.28, "90th_percentile": 12.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 12.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 12.0, "10th_percentile": 12.0, "90th_percentile": 12.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 12.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 12.0, "10th_percentile": 12.0, "90th_percentile": 12.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 13.0, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 13.0, "10th_percentile": 13.0, "90th_percentile": 13.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 13.0, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 13.0, "10th_percentile": 13.0, "90th_percentile": 13.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 20.0, "10th_percentile": 20.0, "90th_percentile": 20.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 20.0, "10th_percentile": 20.0, "90th_percentile": 20.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 20.0, "10th_percentile": 20.0, "90th_percentile": 20.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 20.0, "10th_percentile": 20.0, "90th_percentile": 20.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 20.0, "10th_percentile": 20.0, "90th_percentile": 20.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 11.24, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 11.24, "10th_percentile": 11.24, "90th_percentile": 11.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 9.4, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 9.4, "10th_percentile": 9.4, "90th_percentile": 9.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 8.4, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 8.4, "10th_percentile": 8.4, "90th_percentile": 8.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 11.69, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.69, "10th_percentile": 11.69, "90th_percentile": 11.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 12.28, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 12.28, "10th_percentile": 12.28, "90th_percentile": 12.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 10.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 10.0, "10th_percentile": 10.0, "90th_percentile": 10.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 12.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.0, "10th_percentile": 12.0, "90th_percentile": 12.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH AETNA", "standard_charge_dollar": 11.24, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 11.24, "10th_percentile": 11.24, "90th_percentile": 11.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 13.38, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.38, "10th_percentile": 13.38, "90th_percentile": 13.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 17.4, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 17.4, "10th_percentile": 17.4, "90th_percentile": 17.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 12.6, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 12.6, "10th_percentile": 12.6, "90th_percentile": 12.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 12.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 12.0, "10th_percentile": 12.0, "90th_percentile": 12.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 13.0, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 13.0, "10th_percentile": 13.0, "90th_percentile": 13.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 12.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 12.0, "10th_percentile": 12.0, "90th_percentile": 12.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 8.4, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 8.4, "10th_percentile": 8.4, "90th_percentile": 8.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 16.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 16.0, "10th_percentile": 16.0, "90th_percentile": 16.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 10.87, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 10.87, "10th_percentile": 10.87, "90th_percentile": 10.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 9.72, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.72, "10th_percentile": 9.72, "90th_percentile": 9.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 9.7, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.7, "10th_percentile": 9.7, "90th_percentile": 9.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $20.00 @ 12.5% = $2.50 due to $0.00 Claim Price", "median_amount": 2.5, "10th_percentile": 2.5, "90th_percentile": 2.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $20.00 @ 12.5% = $2.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $20.00 @ 12.5% = $2.50 due to $0.00 Claim Price", "median_amount": 2.5, "10th_percentile": 2.5, "90th_percentile": 2.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $20.00 @ 12.5% = $2.50 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $20.00 @ 12.5% = $2.50 due to $0.00 Claim Price", "median_amount": 2.5, "10th_percentile": 2.5, "90th_percentile": 2.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $20.00 @ 12.5% = $2.50 due to $0.00 Claim Price" } ] } ] }, { "description": "DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "RX-2332", "type": "CDM" }, { "code": "J1100", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "63323-0165-30", "type": "NDC" } ], "standard_charges": [ { "minimum": 41.9, "maximum": 99.75, "setting": "outpatient", "gross_charge": 99.75, "discounted_cash": 69.82, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $99.75 @ 12.5% = $12.47 due to $0.00 Claim Price", "median_amount": 12.47, "10th_percentile": 12.47, "90th_percentile": 12.47, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $99.75 @ 12.5% = $12.47 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $99.75 @ 12.5% = $12.47 due to $0.00 Claim Price", "median_amount": 12.47, "10th_percentile": 12.47, "90th_percentile": 12.47, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $99.75 @ 12.5% = $12.47 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $99.75 @ 12.5% = $12.47 due to $0.00 Claim Price", "median_amount": 12.47, "10th_percentile": 12.47, "90th_percentile": 12.47, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $99.75 @ 12.5% = $12.47 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 99.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 99.75, "10th_percentile": 99.75, "90th_percentile": 99.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 99.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 99.75, "10th_percentile": 99.75, "90th_percentile": 99.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 99.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 99.75, "10th_percentile": 99.75, "90th_percentile": 99.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 99.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 99.75, "10th_percentile": 99.75, "90th_percentile": 99.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 99.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 99.75, "10th_percentile": 99.75, "90th_percentile": 99.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 56.06, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 56.06, "10th_percentile": 56.06, "90th_percentile": 56.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH AETNA", "standard_charge_dollar": 56.06, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 56.06, "10th_percentile": 56.06, "90th_percentile": 56.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 59.85, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 59.85, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "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; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 59.85, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 66.73, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 66.73, "10th_percentile": 66.73, "90th_percentile": 66.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 48.38, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 48.38, "10th_percentile": 48.38, "90th_percentile": 48.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS HMO", "standard_charge_dollar": 58.29, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 58.29, "10th_percentile": 58.29, "90th_percentile": 58.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 48.48, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 48.48, "10th_percentile": 48.48, "90th_percentile": 48.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH PHCS", "standard_charge_dollar": 79.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 79.8, "10th_percentile": 79.8, "90th_percentile": 79.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 49.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 49.88, "10th_percentile": 49.88, "90th_percentile": 49.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 62.84, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 62.84, "10th_percentile": 62.84, "90th_percentile": 62.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 54.21, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 54.21, "10th_percentile": 54.21, "90th_percentile": 54.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 86.78, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 86.78, "10th_percentile": 86.78, "90th_percentile": 86.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 64.84, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 64.84, "10th_percentile": 64.84, "90th_percentile": 64.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 46.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 46.88, "10th_percentile": 46.88, "90th_percentile": 46.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 61.25, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 61.25, "10th_percentile": 61.25, "90th_percentile": 61.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 41.9, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 41.9, "10th_percentile": 41.9, "90th_percentile": 41.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 41.9, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 41.9, "10th_percentile": 41.9, "90th_percentile": 41.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 54.36, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 54.36, "10th_percentile": 54.36, "90th_percentile": 54.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 54.36, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 54.36, "10th_percentile": 54.36, "90th_percentile": 54.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 54.36, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 54.36, "10th_percentile": 54.36, "90th_percentile": 54.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 55.76, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 55.76, "10th_percentile": 55.76, "90th_percentile": 55.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 58.29, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 58.29, "10th_percentile": 58.29, "90th_percentile": 58.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 64.84, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 64.84, "10th_percentile": 64.84, "90th_percentile": 64.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 59.85, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "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; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 61.25, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 61.25, "10th_percentile": 61.25, "90th_percentile": 61.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 59.85, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 64.84, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 64.84, "10th_percentile": 64.84, "90th_percentile": 64.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" } ] } ] }, { "description": "DEXTROSE 10 % IN WATER (D10W) 10 % IV SOLP", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "RX-91404", "type": "CDM" }, { "code": "25800000", "type": "LOCAL" }, { "code": "0258", "type": "RC" }, { "code": "00264-7520-00", "type": "NDC" } ], "standard_charges": [ { "minimum": 43.47, "maximum": 103.5, "setting": "outpatient", "gross_charge": 103.5, "discounted_cash": 72.45, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 52.74, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 52.74, "10th_percentile": 52.74, "90th_percentile": 52.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 60.49, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 60.49, "10th_percentile": 60.49, "90th_percentile": 60.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 57.86, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 57.86, "10th_percentile": 57.86, "90th_percentile": 57.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 59.7, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 59.7, "10th_percentile": 59.7, "90th_percentile": 59.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 62.1, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 62.1, "10th_percentile": 62.1, "90th_percentile": 62.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 67.28, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 67.28, "10th_percentile": 67.28, "90th_percentile": 67.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 67.28, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 67.28, "10th_percentile": 67.28, "90th_percentile": 67.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 62.1, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 62.1, "10th_percentile": 62.1, "90th_percentile": 62.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 48.65, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 48.65, "10th_percentile": 48.65, "90th_percentile": 48.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 43.47, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 43.47, "10th_percentile": 43.47, "90th_percentile": 43.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 60.49, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 60.49, "10th_percentile": 60.49, "90th_percentile": 60.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 59.7, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 59.7, "10th_percentile": 59.7, "90th_percentile": 59.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 51.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 51.75, "10th_percentile": 51.75, "90th_percentile": 51.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 62.1, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 62.1, "10th_percentile": 62.1, "90th_percentile": 62.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 69.24, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 69.24, "10th_percentile": 69.24, "90th_percentile": 69.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 90.05, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 90.05, "10th_percentile": 90.05, "90th_percentile": 90.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 65.21, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 65.21, "10th_percentile": 65.21, "90th_percentile": 65.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 62.1, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 62.1, "10th_percentile": 62.1, "90th_percentile": 62.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 67.28, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 67.28, "10th_percentile": 67.28, "90th_percentile": 67.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 62.1, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 62.1, "10th_percentile": 62.1, "90th_percentile": 62.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 43.47, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 43.47, "10th_percentile": 43.47, "90th_percentile": 43.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 82.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% 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 Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 56.25, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 56.25, "10th_percentile": 56.25, "90th_percentile": 56.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 50.2, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 50.2, "10th_percentile": 50.2, "90th_percentile": 50.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 103.5, "10th_percentile": 103.5, "90th_percentile": 103.5, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 103.5, "10th_percentile": 103.5, "90th_percentile": 103.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 103.5, "10th_percentile": 103.5, "90th_percentile": 103.5, "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": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_algorithm": "No contract line matched", "median_amount": 103.5, "10th_percentile": 103.5, "90th_percentile": 103.5, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_algorithm": "No contract line matched", "median_amount": 103.5, "10th_percentile": 103.5, "90th_percentile": 103.5, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 103.5, "10th_percentile": 103.5, "90th_percentile": 103.5, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 103.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 103.5, "10th_percentile": 103.5, "90th_percentile": 103.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 103.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 103.5, "10th_percentile": 103.5, "90th_percentile": 103.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 103.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 103.5, "10th_percentile": 103.5, "90th_percentile": 103.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 103.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 103.5, "10th_percentile": 103.5, "90th_percentile": 103.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 103.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 103.5, "10th_percentile": 103.5, "90th_percentile": 103.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "DIGOXIN 125 MCG (0.125 MG) ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-2444", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "42292-0003-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 7.77, "maximum": 18.5, "setting": "outpatient", "gross_charge": 18.5, "discounted_cash": 12.95, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 12.03, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 12.03, "10th_percentile": 12.03, "90th_percentile": 12.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 11.1, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 11.1, "10th_percentile": 11.1, "90th_percentile": 11.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 10.34, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 10.34, "10th_percentile": 10.34, "90th_percentile": 10.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 10.81, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.81, "10th_percentile": 10.81, "90th_percentile": 10.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 10.67, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 10.67, "10th_percentile": 10.67, "90th_percentile": 10.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 12.03, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 12.03, "10th_percentile": 12.03, "90th_percentile": 12.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 9.43, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 9.43, "10th_percentile": 9.43, "90th_percentile": 9.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 11.1, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 11.1, "10th_percentile": 11.1, "90th_percentile": 11.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 8.98, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 8.98, "10th_percentile": 8.98, "90th_percentile": 8.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 8.98, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 8.98, "10th_percentile": 8.98, "90th_percentile": 8.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 8.7, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 8.7, "10th_percentile": 8.7, "90th_percentile": 8.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 10.81, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.81, "10th_percentile": 10.81, "90th_percentile": 10.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 10.67, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 10.67, "10th_percentile": 10.67, "90th_percentile": 10.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 9.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 9.25, "10th_percentile": 9.25, "90th_percentile": 9.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 12.38, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.38, "10th_percentile": 12.38, "90th_percentile": 12.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 16.1, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 16.1, "10th_percentile": 16.1, "90th_percentile": 16.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 11.66, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 11.66, "10th_percentile": 11.66, "90th_percentile": 11.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 12.03, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 12.03, "10th_percentile": 12.03, "90th_percentile": 12.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 14.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 14.8, "10th_percentile": 14.8, "90th_percentile": 14.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 10.05, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 10.05, "10th_percentile": 10.05, "90th_percentile": 10.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 8.99, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.99, "10th_percentile": 8.99, "90th_percentile": 8.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 8.97, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.97, "10th_percentile": 8.97, "90th_percentile": 8.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 11.1, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 11.1, "10th_percentile": 11.1, "90th_percentile": 11.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 11.1, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.1, "10th_percentile": 11.1, "90th_percentile": 11.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 11.1, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 11.1, "10th_percentile": 11.1, "90th_percentile": 11.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 7.77, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 7.77, "10th_percentile": 7.77, "90th_percentile": 7.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 7.77, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 7.77, "10th_percentile": 7.77, "90th_percentile": 7.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 18.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 18.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 18.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 18.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 18.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "DILTIAZEM HCL 240 MG ORAL CP24", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-29274", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "60687-0217-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 2.21, "maximum": 5.25, "setting": "outpatient", "gross_charge": 5.25, "discounted_cash": 3.67, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 3.41, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 3.15, "10th_percentile": 3.15, "90th_percentile": 3.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.93, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.93, "10th_percentile": 2.93, "90th_percentile": 2.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3.07, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.07, "10th_percentile": 3.07, "90th_percentile": 3.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3.03, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 3.03, "10th_percentile": 3.03, "90th_percentile": 3.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 3.41, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 3.41, "10th_percentile": 3.41, "90th_percentile": 3.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.68, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 3.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3.15, "10th_percentile": 3.15, "90th_percentile": 3.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2.55, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% 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; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2.55, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% 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; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2.47, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2.47, "10th_percentile": 2.47, "90th_percentile": 2.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3.07, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.07, "10th_percentile": 3.07, "90th_percentile": 3.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 3.03, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 3.03, "10th_percentile": 3.03, "90th_percentile": 3.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.63, "10th_percentile": 2.63, "90th_percentile": 2.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 3.51, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.51, "10th_percentile": 3.51, "90th_percentile": 3.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 4.57, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 4.57, "10th_percentile": 4.57, "90th_percentile": 4.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 3.31, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 3.31, "10th_percentile": 3.31, "90th_percentile": 3.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 3.41, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 3.41, "10th_percentile": 3.41, "90th_percentile": 3.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 4.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.85, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.85, "10th_percentile": 2.85, "90th_percentile": 2.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 2.55, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.55, "10th_percentile": 2.55, "90th_percentile": 2.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 2.55, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.55, "10th_percentile": 2.55, "90th_percentile": 2.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 3.15, "10th_percentile": 3.15, "90th_percentile": 3.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 3.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.15, "10th_percentile": 3.15, "90th_percentile": 3.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 3.15, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3.15, "10th_percentile": 3.15, "90th_percentile": 3.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2.21, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2.21, "10th_percentile": 2.21, "90th_percentile": 2.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2.21, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2.21, "10th_percentile": 2.21, "90th_percentile": 2.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "DIPHENHYDRAMINE HCL 2.5 MG/ML ORAL LIQD", "drug_information": { "unit": 118.0, "type": "ML" }, "code_information": [ { "code": "RX-12556", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "50580-0535-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 32.97, "maximum": 78.5, "setting": "outpatient", "gross_charge": 78.5, "discounted_cash": 54.95, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 38.1, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 38.1, "10th_percentile": 38.1, "90th_percentile": 38.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 38.1, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 38.1, "10th_percentile": 38.1, "90th_percentile": 38.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 47.1, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 47.1, "10th_percentile": 47.1, "90th_percentile": 47.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 43.88, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 43.88, "10th_percentile": 43.88, "90th_percentile": 43.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 45.88, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.88, "10th_percentile": 45.88, "90th_percentile": 45.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 45.28, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 45.28, "10th_percentile": 45.28, "90th_percentile": 45.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 40.0, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 51.03, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 51.03, "10th_percentile": 51.03, "90th_percentile": 51.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 47.1, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 47.1, "10th_percentile": 47.1, "90th_percentile": 47.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 51.03, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 51.03, "10th_percentile": 51.03, "90th_percentile": 51.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 39.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 39.25, "10th_percentile": 39.25, "90th_percentile": 39.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH UHC CORE", "standard_charge_dollar": 38.07, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 38.07, "10th_percentile": 38.07, "90th_percentile": 38.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 49.46, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 49.46, "10th_percentile": 49.46, "90th_percentile": 49.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 36.9, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 36.9, "10th_percentile": 36.9, "90th_percentile": 36.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 45.88, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.88, "10th_percentile": 45.88, "90th_percentile": 45.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 45.28, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 45.28, "10th_percentile": 45.28, "90th_percentile": 45.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 68.3, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 68.3, "10th_percentile": 68.3, "90th_percentile": 68.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 52.52, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 52.52, "10th_percentile": 52.52, "90th_percentile": 52.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 51.03, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 51.03, "10th_percentile": 51.03, "90th_percentile": 51.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 42.66, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 42.66, "10th_percentile": 42.66, "90th_percentile": 42.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 62.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 62.8, "10th_percentile": 62.8, "90th_percentile": 62.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 38.15, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 38.15, "10th_percentile": 38.15, "90th_percentile": 38.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 47.1, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 47.1, "10th_percentile": 47.1, "90th_percentile": 47.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 47.1, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 47.1, "10th_percentile": 47.1, "90th_percentile": 47.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 47.1, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 47.1, "10th_percentile": 47.1, "90th_percentile": 47.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 32.97, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 32.97, "10th_percentile": 32.97, "90th_percentile": 32.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 32.97, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 32.97, "10th_percentile": 32.97, "90th_percentile": 32.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 78.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 78.5, "10th_percentile": 78.5, "90th_percentile": 78.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 78.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 78.5, "10th_percentile": 78.5, "90th_percentile": 78.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 78.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 78.5, "10th_percentile": 78.5, "90th_percentile": 78.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 78.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 78.5, "10th_percentile": 78.5, "90th_percentile": 78.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 78.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 78.5, "10th_percentile": 78.5, "90th_percentile": 78.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 78.5, "10th_percentile": 78.5, "90th_percentile": 78.5, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 78.5, "10th_percentile": 78.5, "90th_percentile": 78.5, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 78.5, "10th_percentile": 78.5, "90th_percentile": 78.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "DIPHENHYDRAMINE HCL 2.5 MG/ML ORAL LIQD", "drug_information": { "unit": 118.0, "type": "ML" }, "code_information": [ { "code": "RX-12556", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "87701-0649-54", "type": "NDC" } ], "standard_charges": [ { "minimum": 5.88, "maximum": 14.0, "setting": "outpatient", "gross_charge": 14.0, "discounted_cash": 9.8, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 6.79, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% 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; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 6.79, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% 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; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 8.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 8.4, "10th_percentile": 8.4, "90th_percentile": 8.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 7.83, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 7.83, "10th_percentile": 7.83, "90th_percentile": 7.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 8.18, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.18, "10th_percentile": 8.18, "90th_percentile": 8.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 8.08, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 8.08, "10th_percentile": 8.08, "90th_percentile": 8.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 7.13, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 7.13, "10th_percentile": 7.13, "90th_percentile": 7.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 9.1, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% 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; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 8.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 8.4, "10th_percentile": 8.4, "90th_percentile": 8.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 9.1, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 9.1, "10th_percentile": 9.1, "90th_percentile": 9.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 7.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH UHC CORE", "standard_charge_dollar": 6.79, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.79, "10th_percentile": 6.79, "90th_percentile": 6.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 8.82, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 8.82, "10th_percentile": 8.82, "90th_percentile": 8.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 6.58, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 6.58, "10th_percentile": 6.58, "90th_percentile": 6.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 8.18, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.18, "10th_percentile": 8.18, "90th_percentile": 8.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 8.08, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 8.08, "10th_percentile": 8.08, "90th_percentile": 8.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 12.18, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 12.18, "10th_percentile": 12.18, "90th_percentile": 12.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 9.37, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.37, "10th_percentile": 9.37, "90th_percentile": 9.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 9.1, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% 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; 65% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 7.61, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 7.61, "10th_percentile": 7.61, "90th_percentile": 7.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 11.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 11.2, "10th_percentile": 11.2, "90th_percentile": 11.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 6.8, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.8, "10th_percentile": 6.8, "90th_percentile": 6.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 8.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 8.4, "10th_percentile": 8.4, "90th_percentile": 8.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 8.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.4, "10th_percentile": 8.4, "90th_percentile": 8.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 8.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 8.4, "10th_percentile": 8.4, "90th_percentile": 8.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 5.88, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 5.88, "10th_percentile": 5.88, "90th_percentile": 5.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 5.88, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 5.88, "10th_percentile": 5.88, "90th_percentile": 5.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14.0, "10th_percentile": 14.0, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14.0, "10th_percentile": 14.0, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14.0, "10th_percentile": 14.0, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14.0, "10th_percentile": 14.0, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14.0, "10th_percentile": 14.0, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.0, "10th_percentile": 14.0, "90th_percentile": 14.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.0, "10th_percentile": 14.0, "90th_percentile": 14.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.0, "10th_percentile": 14.0, "90th_percentile": 14.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "DOCUSATE SODIUM 100 MG ORAL CAP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-2566", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "60687-0129-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.53, "maximum": 1.25, "setting": "outpatient", "gross_charge": 1.25, "discounted_cash": 0.87, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 0.81, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 0.81, "10th_percentile": 0.81, "90th_percentile": 0.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.75, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.75, "10th_percentile": 0.75, "90th_percentile": 0.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 0.7, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 0.7, "10th_percentile": 0.7, "90th_percentile": 0.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 0.73, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.73, "10th_percentile": 0.73, "90th_percentile": 0.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 0.72, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% 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; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.81, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.81, "10th_percentile": 0.81, "90th_percentile": 0.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 0.64, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 0.64, "10th_percentile": 0.64, "90th_percentile": 0.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 0.75, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.75, "10th_percentile": 0.75, "90th_percentile": 0.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 0.61, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.61, "10th_percentile": 0.61, "90th_percentile": 0.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 0.61, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.61, "10th_percentile": 0.61, "90th_percentile": 0.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.59, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 0.59, "10th_percentile": 0.59, "90th_percentile": 0.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 0.73, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.73, "10th_percentile": 0.73, "90th_percentile": 0.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 0.72, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% 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; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 0.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 0.84, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 1.09, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 1.09, "10th_percentile": 1.09, "90th_percentile": 1.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 0.79, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 0.79, "10th_percentile": 0.79, "90th_percentile": 0.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.81, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.81, "10th_percentile": 0.81, "90th_percentile": 0.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 0.68, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 0.68, "10th_percentile": 0.68, "90th_percentile": 0.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 0.61, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.61, "10th_percentile": 0.61, "90th_percentile": 0.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 0.61, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.61, "10th_percentile": 0.61, "90th_percentile": 0.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.75, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.75, "10th_percentile": 0.75, "90th_percentile": 0.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 0.75, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.75, "10th_percentile": 0.75, "90th_percentile": 0.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 0.75, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.75, "10th_percentile": 0.75, "90th_percentile": 0.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.53, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.53, "10th_percentile": 0.53, "90th_percentile": 0.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.53, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.53, "10th_percentile": 0.53, "90th_percentile": 0.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.25, "10th_percentile": 1.25, "90th_percentile": 1.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.25, "10th_percentile": 1.25, "90th_percentile": 1.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.25, "10th_percentile": 1.25, "90th_percentile": 1.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.25, "10th_percentile": 1.25, "90th_percentile": 1.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.25, "10th_percentile": 1.25, "90th_percentile": 1.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.25, "10th_percentile": 1.25, "90th_percentile": 1.25, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.25, "10th_percentile": 1.25, "90th_percentile": 1.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.25, "10th_percentile": 1.25, "90th_percentile": 1.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "DOFETILIDE 250 MCG ORAL CAP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-26966", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "59762-0038-02", "type": "NDC" } ], "standard_charges": [ { "minimum": 24.05, "maximum": 57.25, "setting": "outpatient", "gross_charge": 57.25, "discounted_cash": 40.07, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 37.21, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 37.21, "10th_percentile": 37.21, "90th_percentile": 37.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 34.35, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 34.35, "10th_percentile": 34.35, "90th_percentile": 34.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 32.0, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 32.0, "10th_percentile": 32.0, "90th_percentile": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 33.46, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 33.46, "10th_percentile": 33.46, "90th_percentile": 33.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 33.02, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% 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; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 37.21, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 37.21, "10th_percentile": 37.21, "90th_percentile": 37.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 29.17, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 29.17, "10th_percentile": 29.17, "90th_percentile": 29.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 34.35, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 34.35, "10th_percentile": 34.35, "90th_percentile": 34.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 27.78, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 27.78, "10th_percentile": 27.78, "90th_percentile": 27.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 27.78, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 27.78, "10th_percentile": 27.78, "90th_percentile": 27.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 26.91, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 26.91, "10th_percentile": 26.91, "90th_percentile": 26.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 33.46, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 33.46, "10th_percentile": 33.46, "90th_percentile": 33.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 33.02, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% 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; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 28.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 28.63, "10th_percentile": 28.63, "90th_percentile": 28.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 38.3, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 38.3, "10th_percentile": 38.3, "90th_percentile": 38.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 49.81, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 49.81, "10th_percentile": 49.81, "90th_percentile": 49.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 36.07, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 36.07, "10th_percentile": 36.07, "90th_percentile": 36.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 37.21, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 37.21, "10th_percentile": 37.21, "90th_percentile": 37.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 45.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 45.8, "10th_percentile": 45.8, "90th_percentile": 45.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 31.12, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 31.12, "10th_percentile": 31.12, "90th_percentile": 31.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 27.82, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 27.82, "10th_percentile": 27.82, "90th_percentile": 27.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 27.77, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 27.77, "10th_percentile": 27.77, "90th_percentile": 27.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 34.35, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 34.35, "10th_percentile": 34.35, "90th_percentile": 34.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 34.35, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 34.35, "10th_percentile": 34.35, "90th_percentile": 34.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 34.35, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 34.35, "10th_percentile": 34.35, "90th_percentile": 34.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 24.05, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 24.05, "10th_percentile": 24.05, "90th_percentile": 24.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 24.05, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 24.05, "10th_percentile": 24.05, "90th_percentile": 24.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 57.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 57.25, "10th_percentile": 57.25, "90th_percentile": 57.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 57.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 57.25, "10th_percentile": 57.25, "90th_percentile": 57.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 57.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 57.25, "10th_percentile": 57.25, "90th_percentile": 57.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 57.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 57.25, "10th_percentile": 57.25, "90th_percentile": 57.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 57.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 57.25, "10th_percentile": 57.25, "90th_percentile": 57.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 57.25, "10th_percentile": 57.25, "90th_percentile": 57.25, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 57.25, "10th_percentile": 57.25, "90th_percentile": 57.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 57.25, "10th_percentile": 57.25, "90th_percentile": 57.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "DOXAZOSIN 4 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-9896", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00904-5524-61", "type": "NDC" } ], "standard_charges": [ { "minimum": 3.47, "maximum": 8.25, "setting": "outpatient", "gross_charge": 8.25, "discounted_cash": 5.77, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 5.36, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 5.36, "10th_percentile": 5.36, "90th_percentile": 5.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 4.95, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 4.95, "10th_percentile": 4.95, "90th_percentile": 4.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 4.61, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 4.61, "10th_percentile": 4.61, "90th_percentile": 4.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 4.82, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.82, "10th_percentile": 4.82, "90th_percentile": 4.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 4.76, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 4.76, "10th_percentile": 4.76, "90th_percentile": 4.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 5.36, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 5.36, "10th_percentile": 5.36, "90th_percentile": 5.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 4.2, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 4.95, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 4.95, "10th_percentile": 4.95, "90th_percentile": 4.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 4.0, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 4.0, "10th_percentile": 4.0, "90th_percentile": 4.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 4.0, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 4.0, "10th_percentile": 4.0, "90th_percentile": 4.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 3.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 3.88, "10th_percentile": 3.88, "90th_percentile": 3.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 4.82, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.82, "10th_percentile": 4.82, "90th_percentile": 4.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 4.76, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 4.76, "10th_percentile": 4.76, "90th_percentile": 4.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 4.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 4.13, "10th_percentile": 4.13, "90th_percentile": 4.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 5.52, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.52, "10th_percentile": 5.52, "90th_percentile": 5.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 7.18, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 7.18, "10th_percentile": 7.18, "90th_percentile": 7.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 5.2, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% 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; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 5.36, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 5.36, "10th_percentile": 5.36, "90th_percentile": 5.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 6.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 4.48, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 4.48, "10th_percentile": 4.48, "90th_percentile": 4.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 4.01, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 4.0, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.0, "10th_percentile": 4.0, "90th_percentile": 4.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 4.95, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 4.95, "10th_percentile": 4.95, "90th_percentile": 4.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 4.95, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.95, "10th_percentile": 4.95, "90th_percentile": 4.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 4.95, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 4.95, "10th_percentile": 4.95, "90th_percentile": 4.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 3.47, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 3.47, "10th_percentile": 3.47, "90th_percentile": 3.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 3.47, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 3.47, "10th_percentile": 3.47, "90th_percentile": 3.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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" } ] } ] }, { "description": "DOXAZOSIN 4 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-9896", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "68084-0862-11", "type": "NDC" } ], "standard_charges": [ { "minimum": 2.84, "maximum": 6.75, "setting": "outpatient", "gross_charge": 6.75, "discounted_cash": 4.72, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 4.39, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 4.39, "10th_percentile": 4.39, "90th_percentile": 4.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 4.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 4.05, "10th_percentile": 4.05, "90th_percentile": 4.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3.77, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 3.77, "10th_percentile": 3.77, "90th_percentile": 3.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3.94, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.94, "10th_percentile": 3.94, "90th_percentile": 3.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3.89, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 3.89, "10th_percentile": 3.89, "90th_percentile": 3.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 4.39, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 4.39, "10th_percentile": 4.39, "90th_percentile": 4.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3.44, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 3.44, "10th_percentile": 3.44, "90th_percentile": 3.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 4.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 4.05, "10th_percentile": 4.05, "90th_percentile": 4.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 3.28, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 3.28, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 3.17, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 3.17, "10th_percentile": 3.17, "90th_percentile": 3.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3.94, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.94, "10th_percentile": 3.94, "90th_percentile": 3.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 3.89, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 3.89, "10th_percentile": 3.89, "90th_percentile": 3.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 3.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 3.38, "10th_percentile": 3.38, "90th_percentile": 3.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 4.52, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.52, "10th_percentile": 4.52, "90th_percentile": 4.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 5.87, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 5.87, "10th_percentile": 5.87, "90th_percentile": 5.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 4.25, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 4.25, "10th_percentile": 4.25, "90th_percentile": 4.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 4.39, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 4.39, "10th_percentile": 4.39, "90th_percentile": 4.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 5.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 5.4, "10th_percentile": 5.4, "90th_percentile": 5.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 3.67, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 3.67, "10th_percentile": 3.67, "90th_percentile": 3.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 3.28, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.28, "10th_percentile": 3.28, "90th_percentile": 3.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 3.27, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.27, "10th_percentile": 3.27, "90th_percentile": 3.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 4.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 4.05, "10th_percentile": 4.05, "90th_percentile": 4.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 4.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.05, "10th_percentile": 4.05, "90th_percentile": 4.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 4.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 4.05, "10th_percentile": 4.05, "90th_percentile": 4.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2.84, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2.84, "10th_percentile": 2.84, "90th_percentile": 2.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2.84, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2.84, "10th_percentile": 2.84, "90th_percentile": 2.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.75, "10th_percentile": 6.75, "90th_percentile": 6.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.75, "10th_percentile": 6.75, "90th_percentile": 6.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.75, "10th_percentile": 6.75, "90th_percentile": 6.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.75, "10th_percentile": 6.75, "90th_percentile": 6.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.75, "10th_percentile": 6.75, "90th_percentile": 6.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6.75, "10th_percentile": 6.75, "90th_percentile": 6.75, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6.75, "10th_percentile": 6.75, "90th_percentile": 6.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6.75, "10th_percentile": 6.75, "90th_percentile": 6.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "DOXAZOSIN 4 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-9896", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "68084-0862-25", "type": "NDC" } ], "standard_charges": [ { "minimum": 4.41, "maximum": 10.5, "setting": "outpatient", "gross_charge": 10.5, "discounted_cash": 7.35, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 6.83, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 6.83, "10th_percentile": 6.83, "90th_percentile": 6.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 6.3, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 6.3, "10th_percentile": 6.3, "90th_percentile": 6.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 5.87, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 5.87, "10th_percentile": 5.87, "90th_percentile": 5.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 6.14, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.14, "10th_percentile": 6.14, "90th_percentile": 6.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 6.06, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 6.06, "10th_percentile": 6.06, "90th_percentile": 6.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 6.83, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 6.83, "10th_percentile": 6.83, "90th_percentile": 6.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 5.35, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 5.35, "10th_percentile": 5.35, "90th_percentile": 5.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 6.3, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 6.3, "10th_percentile": 6.3, "90th_percentile": 6.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 5.1, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 5.1, "10th_percentile": 5.1, "90th_percentile": 5.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 5.1, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 5.1, "10th_percentile": 5.1, "90th_percentile": 5.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 4.94, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 4.94, "10th_percentile": 4.94, "90th_percentile": 4.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 6.14, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.14, "10th_percentile": 6.14, "90th_percentile": 6.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 6.06, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 6.06, "10th_percentile": 6.06, "90th_percentile": 6.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 5.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 7.02, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.02, "10th_percentile": 7.02, "90th_percentile": 7.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 9.14, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 9.14, "10th_percentile": 9.14, "90th_percentile": 9.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 6.62, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 6.62, "10th_percentile": 6.62, "90th_percentile": 6.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 6.83, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 6.83, "10th_percentile": 6.83, "90th_percentile": 6.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 8.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 8.4, "10th_percentile": 8.4, "90th_percentile": 8.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 5.71, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 5.71, "10th_percentile": 5.71, "90th_percentile": 5.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 5.1, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.1, "10th_percentile": 5.1, "90th_percentile": 5.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 5.09, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.09, "10th_percentile": 5.09, "90th_percentile": 5.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 6.3, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 6.3, "10th_percentile": 6.3, "90th_percentile": 6.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 6.3, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.3, "10th_percentile": 6.3, "90th_percentile": 6.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 6.3, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 6.3, "10th_percentile": 6.3, "90th_percentile": 6.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 4.41, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 4.41, "10th_percentile": 4.41, "90th_percentile": 4.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 4.41, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 4.41, "10th_percentile": 4.41, "90th_percentile": 4.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "DOXAZOSIN 4 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-9896", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "68084-0862-95", "type": "NDC" } ], "standard_charges": [ { "minimum": 4.41, "maximum": 10.5, "setting": "outpatient", "gross_charge": 10.5, "discounted_cash": 7.35, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 6.83, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 6.83, "10th_percentile": 6.83, "90th_percentile": 6.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 6.3, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 6.3, "10th_percentile": 6.3, "90th_percentile": 6.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 5.87, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 5.87, "10th_percentile": 5.87, "90th_percentile": 5.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 6.14, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.14, "10th_percentile": 6.14, "90th_percentile": 6.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 6.06, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 6.06, "10th_percentile": 6.06, "90th_percentile": 6.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 6.83, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 6.83, "10th_percentile": 6.83, "90th_percentile": 6.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 5.35, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 5.35, "10th_percentile": 5.35, "90th_percentile": 5.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 6.3, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 6.3, "10th_percentile": 6.3, "90th_percentile": 6.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 5.1, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 5.1, "10th_percentile": 5.1, "90th_percentile": 5.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 5.1, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 5.1, "10th_percentile": 5.1, "90th_percentile": 5.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 4.94, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 4.94, "10th_percentile": 4.94, "90th_percentile": 4.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 6.14, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.14, "10th_percentile": 6.14, "90th_percentile": 6.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 6.06, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 6.06, "10th_percentile": 6.06, "90th_percentile": 6.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 5.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 5.25, "10th_percentile": 5.25, "90th_percentile": 5.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 7.02, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.02, "10th_percentile": 7.02, "90th_percentile": 7.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 9.14, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 9.14, "10th_percentile": 9.14, "90th_percentile": 9.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 6.62, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 6.62, "10th_percentile": 6.62, "90th_percentile": 6.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 6.83, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 6.83, "10th_percentile": 6.83, "90th_percentile": 6.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 8.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 8.4, "10th_percentile": 8.4, "90th_percentile": 8.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 5.71, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 5.71, "10th_percentile": 5.71, "90th_percentile": 5.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 5.1, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.1, "10th_percentile": 5.1, "90th_percentile": 5.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 5.09, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.09, "10th_percentile": 5.09, "90th_percentile": 5.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 6.3, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 6.3, "10th_percentile": 6.3, "90th_percentile": 6.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 6.3, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.3, "10th_percentile": 6.3, "90th_percentile": 6.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 6.3, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 6.3, "10th_percentile": 6.3, "90th_percentile": 6.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 4.41, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 4.41, "10th_percentile": 4.41, "90th_percentile": 4.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 4.41, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 4.41, "10th_percentile": 4.41, "90th_percentile": 4.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "DOXEPIN 150 MG ORAL CAP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-2610", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "49884-0222-03", "type": "NDC" } ], "standard_charges": [ { "minimum": 4.52, "maximum": 10.75, "setting": "outpatient", "gross_charge": 10.75, "discounted_cash": 7.52, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 6.99, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 6.99, "10th_percentile": 6.99, "90th_percentile": 6.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 6.45, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 6.45, "10th_percentile": 6.45, "90th_percentile": 6.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 6.01, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 6.01, "10th_percentile": 6.01, "90th_percentile": 6.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 6.28, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.28, "10th_percentile": 6.28, "90th_percentile": 6.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 6.2, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 6.2, "10th_percentile": 6.2, "90th_percentile": 6.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 6.99, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 6.99, "10th_percentile": 6.99, "90th_percentile": 6.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 5.48, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% 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; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 6.45, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 6.45, "10th_percentile": 6.45, "90th_percentile": 6.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 5.22, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 5.22, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 5.05, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 5.05, "10th_percentile": 5.05, "90th_percentile": 5.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 6.28, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.28, "10th_percentile": 6.28, "90th_percentile": 6.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 6.2, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 6.2, "10th_percentile": 6.2, "90th_percentile": 6.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 5.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 5.38, "10th_percentile": 5.38, "90th_percentile": 5.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 7.19, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.19, "10th_percentile": 7.19, "90th_percentile": 7.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 9.35, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 9.35, "10th_percentile": 9.35, "90th_percentile": 9.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 6.77, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 6.77, "10th_percentile": 6.77, "90th_percentile": 6.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 6.99, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 6.99, "10th_percentile": 6.99, "90th_percentile": 6.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 8.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 8.6, "10th_percentile": 8.6, "90th_percentile": 8.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 5.84, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 5.84, "10th_percentile": 5.84, "90th_percentile": 5.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 5.22, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 5.21, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.21, "10th_percentile": 5.21, "90th_percentile": 5.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 6.45, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 6.45, "10th_percentile": 6.45, "90th_percentile": 6.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 6.45, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.45, "10th_percentile": 6.45, "90th_percentile": 6.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 6.45, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 6.45, "10th_percentile": 6.45, "90th_percentile": 6.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 4.52, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 4.52, "10th_percentile": 4.52, "90th_percentile": 4.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 4.52, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 4.52, "10th_percentile": 4.52, "90th_percentile": 4.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.75, "10th_percentile": 10.75, "90th_percentile": 10.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.75, "10th_percentile": 10.75, "90th_percentile": 10.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.75, "10th_percentile": 10.75, "90th_percentile": 10.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.75, "10th_percentile": 10.75, "90th_percentile": 10.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.75, "10th_percentile": 10.75, "90th_percentile": 10.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 10.75, "10th_percentile": 10.75, "90th_percentile": 10.75, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 10.75, "10th_percentile": 10.75, "90th_percentile": 10.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 10.75, "10th_percentile": 10.75, "90th_percentile": 10.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "DRONABINOL 2.5 MG ORAL CAP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-9904", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "42858-0867-06", "type": "NDC" } ], "standard_charges": [ { "minimum": 11.76, "maximum": 28.0, "setting": "outpatient", "gross_charge": 28.0, "discounted_cash": 19.6, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 18.2, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 16.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 16.8, "10th_percentile": 16.8, "90th_percentile": 16.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 15.65, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 15.65, "10th_percentile": 15.65, "90th_percentile": 15.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 16.36, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 16.36, "10th_percentile": 16.36, "90th_percentile": 16.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 16.15, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 16.15, "10th_percentile": 16.15, "90th_percentile": 16.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 18.2, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 18.2, "10th_percentile": 18.2, "90th_percentile": 18.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 14.27, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 14.27, "10th_percentile": 14.27, "90th_percentile": 14.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 16.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 16.8, "10th_percentile": 16.8, "90th_percentile": 16.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 13.59, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 13.59, "10th_percentile": 13.59, "90th_percentile": 13.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 13.59, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 13.59, "10th_percentile": 13.59, "90th_percentile": 13.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 13.16, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 13.16, "10th_percentile": 13.16, "90th_percentile": 13.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 16.36, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 16.36, "10th_percentile": 16.36, "90th_percentile": 16.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 16.15, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 16.15, "10th_percentile": 16.15, "90th_percentile": 16.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 14.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 14.0, "10th_percentile": 14.0, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 18.73, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.73, "10th_percentile": 18.73, "90th_percentile": 18.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 24.36, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 24.36, "10th_percentile": 24.36, "90th_percentile": 24.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 17.64, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 17.64, "10th_percentile": 17.64, "90th_percentile": 17.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 18.2, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 18.2, "10th_percentile": 18.2, "90th_percentile": 18.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 22.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 22.4, "10th_percentile": 22.4, "90th_percentile": 22.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 15.22, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 15.22, "10th_percentile": 15.22, "90th_percentile": 15.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 13.61, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.61, "10th_percentile": 13.61, "90th_percentile": 13.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 13.58, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.58, "10th_percentile": 13.58, "90th_percentile": 13.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 16.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 16.8, "10th_percentile": 16.8, "90th_percentile": 16.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 16.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 16.8, "10th_percentile": 16.8, "90th_percentile": 16.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 16.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 16.8, "10th_percentile": 16.8, "90th_percentile": 16.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 11.76, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 11.76, "10th_percentile": 11.76, "90th_percentile": 11.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 11.76, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 11.76, "10th_percentile": 11.76, "90th_percentile": 11.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 28.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 28.0, "10th_percentile": 28.0, "90th_percentile": 28.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 28.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 28.0, "10th_percentile": 28.0, "90th_percentile": 28.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 28.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 28.0, "10th_percentile": 28.0, "90th_percentile": 28.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 28.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 28.0, "10th_percentile": 28.0, "90th_percentile": 28.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 28.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 28.0, "10th_percentile": 28.0, "90th_percentile": 28.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 28.0, "10th_percentile": 28.0, "90th_percentile": 28.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 28.0, "10th_percentile": 28.0, "90th_percentile": 28.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 28.0, "10th_percentile": 28.0, "90th_percentile": 28.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "DROXIDOPA 300 MG ORAL CAP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-201576", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "31722-0010-90", "type": "NDC" } ], "standard_charges": [ { "minimum": 7.35, "maximum": 17.5, "setting": "outpatient", "gross_charge": 17.5, "discounted_cash": 12.25, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 11.38, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 11.38, "10th_percentile": 11.38, "90th_percentile": 11.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 10.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 9.78, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 9.78, "10th_percentile": 9.78, "90th_percentile": 9.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 10.23, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.23, "10th_percentile": 10.23, "90th_percentile": 10.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 10.09, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 10.09, "10th_percentile": 10.09, "90th_percentile": 10.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 11.38, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% 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; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 8.92, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 8.92, "10th_percentile": 8.92, "90th_percentile": 8.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 10.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 8.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 8.49, "10th_percentile": 8.49, "90th_percentile": 8.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 8.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 8.49, "10th_percentile": 8.49, "90th_percentile": 8.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 8.23, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 8.23, "10th_percentile": 8.23, "90th_percentile": 8.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 10.23, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.23, "10th_percentile": 10.23, "90th_percentile": 10.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 10.09, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 10.09, "10th_percentile": 10.09, "90th_percentile": 10.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 8.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 8.75, "10th_percentile": 8.75, "90th_percentile": 8.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 11.71, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.71, "10th_percentile": 11.71, "90th_percentile": 11.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 15.23, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 15.23, "10th_percentile": 15.23, "90th_percentile": 15.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 11.03, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 11.03, "10th_percentile": 11.03, "90th_percentile": 11.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 11.38, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% 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; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 14.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 14.0, "10th_percentile": 14.0, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 9.51, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 9.51, "10th_percentile": 9.51, "90th_percentile": 9.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 8.51, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.51, "10th_percentile": 8.51, "90th_percentile": 8.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 8.49, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.49, "10th_percentile": 8.49, "90th_percentile": 8.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 10.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 10.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 10.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 10.5, "10th_percentile": 10.5, "90th_percentile": 10.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 7.35, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 7.35, "10th_percentile": 7.35, "90th_percentile": 7.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 7.35, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 7.35, "10th_percentile": 7.35, "90th_percentile": 7.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 17.5, "10th_percentile": 17.5, "90th_percentile": 17.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 17.5, "10th_percentile": 17.5, "90th_percentile": 17.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 17.5, "10th_percentile": 17.5, "90th_percentile": 17.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 17.5, "10th_percentile": 17.5, "90th_percentile": 17.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 17.5, "10th_percentile": 17.5, "90th_percentile": 17.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 17.5, "10th_percentile": 17.5, "90th_percentile": 17.5, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 17.5, "10th_percentile": 17.5, "90th_percentile": 17.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 17.5, "10th_percentile": 17.5, "90th_percentile": 17.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "EMOLLIENT COMBINATION NO.92 TOP LOTN", "drug_information": { "unit": 177.0, "type": "ML" }, "code_information": [ { "code": "RX-200019", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "52800-0488-16", "type": "NDC" } ], "standard_charges": [ { "minimum": 16.49, "maximum": 39.25, "setting": "outpatient", "gross_charge": 39.25, "discounted_cash": 27.47, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 19.05, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 19.05, "10th_percentile": 19.05, "90th_percentile": 19.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 19.05, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 19.05, "10th_percentile": 19.05, "90th_percentile": 19.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 23.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 23.55, "10th_percentile": 23.55, "90th_percentile": 23.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 21.94, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 21.94, "10th_percentile": 21.94, "90th_percentile": 21.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 22.94, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 22.94, "10th_percentile": 22.94, "90th_percentile": 22.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 22.64, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 22.64, "10th_percentile": 22.64, "90th_percentile": 22.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 20.0, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 20.0, "10th_percentile": 20.0, "90th_percentile": 20.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 25.51, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 25.51, "10th_percentile": 25.51, "90th_percentile": 25.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 23.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 23.55, "10th_percentile": 23.55, "90th_percentile": 23.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 25.51, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 25.51, "10th_percentile": 25.51, "90th_percentile": 25.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 19.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 19.63, "10th_percentile": 19.63, "90th_percentile": 19.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH UHC CORE", "standard_charge_dollar": 19.04, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 19.04, "10th_percentile": 19.04, "90th_percentile": 19.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 24.73, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 24.73, "10th_percentile": 24.73, "90th_percentile": 24.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 18.45, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 18.45, "10th_percentile": 18.45, "90th_percentile": 18.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 22.94, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 22.94, "10th_percentile": 22.94, "90th_percentile": 22.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 22.64, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 22.64, "10th_percentile": 22.64, "90th_percentile": 22.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 34.15, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 34.15, "10th_percentile": 34.15, "90th_percentile": 34.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 26.26, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.26, "10th_percentile": 26.26, "90th_percentile": 26.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 25.51, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 25.51, "10th_percentile": 25.51, "90th_percentile": 25.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 21.33, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 21.33, "10th_percentile": 21.33, "90th_percentile": 21.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 31.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 31.4, "10th_percentile": 31.4, "90th_percentile": 31.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 19.08, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 19.08, "10th_percentile": 19.08, "90th_percentile": 19.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 23.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 23.55, "10th_percentile": 23.55, "90th_percentile": 23.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 23.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.55, "10th_percentile": 23.55, "90th_percentile": 23.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 23.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 23.55, "10th_percentile": 23.55, "90th_percentile": 23.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 16.49, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 16.49, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 39.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 39.25, "10th_percentile": 39.25, "90th_percentile": 39.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 39.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 39.25, "10th_percentile": 39.25, "90th_percentile": 39.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 39.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 39.25, "10th_percentile": 39.25, "90th_percentile": 39.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 39.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 39.25, "10th_percentile": 39.25, "90th_percentile": 39.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 39.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 39.25, "10th_percentile": 39.25, "90th_percentile": 39.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 39.25, "10th_percentile": 39.25, "90th_percentile": 39.25, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 39.25, "10th_percentile": 39.25, "90th_percentile": 39.25, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 39.25, "10th_percentile": 39.25, "90th_percentile": 39.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "EMOLLIENT COMBINATION NO.92 TOP LOTN", "drug_information": { "unit": 177.0, "type": "ML" }, "code_information": [ { "code": "RX-200019", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "52800-0488-26", "type": "NDC" } ], "standard_charges": [ { "minimum": 15.44, "maximum": 36.75, "setting": "outpatient", "gross_charge": 36.75, "discounted_cash": 25.72, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 17.83, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 17.83, "10th_percentile": 17.83, "90th_percentile": 17.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 17.83, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 17.83, "10th_percentile": 17.83, "90th_percentile": 17.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 22.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 22.05, "10th_percentile": 22.05, "90th_percentile": 22.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 20.54, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 20.54, "10th_percentile": 20.54, "90th_percentile": 20.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 21.48, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.48, "10th_percentile": 21.48, "90th_percentile": 21.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 21.2, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 21.2, "10th_percentile": 21.2, "90th_percentile": 21.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 18.73, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 18.73, "10th_percentile": 18.73, "90th_percentile": 18.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 23.89, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 23.89, "10th_percentile": 23.89, "90th_percentile": 23.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 22.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 22.05, "10th_percentile": 22.05, "90th_percentile": 22.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 23.89, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 23.89, "10th_percentile": 23.89, "90th_percentile": 23.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 18.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 18.38, "10th_percentile": 18.38, "90th_percentile": 18.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH UHC CORE", "standard_charge_dollar": 17.82, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17.82, "10th_percentile": 17.82, "90th_percentile": 17.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 23.15, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 23.15, "10th_percentile": 23.15, "90th_percentile": 23.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 17.27, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 17.27, "10th_percentile": 17.27, "90th_percentile": 17.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 21.48, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.48, "10th_percentile": 21.48, "90th_percentile": 21.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 21.2, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 21.2, "10th_percentile": 21.2, "90th_percentile": 21.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 31.97, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 31.97, "10th_percentile": 31.97, "90th_percentile": 31.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 24.59, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 24.59, "10th_percentile": 24.59, "90th_percentile": 24.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 23.89, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 23.89, "10th_percentile": 23.89, "90th_percentile": 23.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 19.97, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 19.97, "10th_percentile": 19.97, "90th_percentile": 19.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 29.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 29.4, "10th_percentile": 29.4, "90th_percentile": 29.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 17.86, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17.86, "10th_percentile": 17.86, "90th_percentile": 17.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 22.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 22.05, "10th_percentile": 22.05, "90th_percentile": 22.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 22.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 22.05, "10th_percentile": 22.05, "90th_percentile": 22.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 22.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 22.05, "10th_percentile": 22.05, "90th_percentile": 22.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 15.44, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 15.44, "10th_percentile": 15.44, "90th_percentile": 15.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 15.44, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 15.44, "10th_percentile": 15.44, "90th_percentile": 15.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 36.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 36.75, "10th_percentile": 36.75, "90th_percentile": 36.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 36.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 36.75, "10th_percentile": 36.75, "90th_percentile": 36.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 36.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 36.75, "10th_percentile": 36.75, "90th_percentile": 36.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 36.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 36.75, "10th_percentile": 36.75, "90th_percentile": 36.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 36.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 36.75, "10th_percentile": 36.75, "90th_percentile": 36.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 36.75, "10th_percentile": 36.75, "90th_percentile": 36.75, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 36.75, "10th_percentile": 36.75, "90th_percentile": 36.75, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 36.75, "10th_percentile": 36.75, "90th_percentile": 36.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ENOXAPARIN 40 MG SUBQ SYRG", "drug_information": { "unit": 0.4, "type": "ML" }, "code_information": [ { "code": "RX-90211", "type": "CDM" }, { "code": "J1650", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00075-0620-40", "type": "NDC" } ], "standard_charges": [ { "minimum": 13.34, "maximum": 31.75, "setting": "outpatient", "gross_charge": 31.75, "discounted_cash": 22.22, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $31.75 @ 12.5% = $3.97 due to $0.00 Claim Price", "median_amount": 3.97, "10th_percentile": 3.97, "90th_percentile": 3.97, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $31.75 @ 12.5% = $3.97 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $31.75 @ 12.5% = $3.97 due to $0.00 Claim Price", "median_amount": 3.97, "10th_percentile": 3.97, "90th_percentile": 3.97, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $31.75 @ 12.5% = $3.97 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $31.75 @ 12.5% = $3.97 due to $0.00 Claim Price", "median_amount": 3.97, "10th_percentile": 3.97, "90th_percentile": 3.97, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $31.75 @ 12.5% = $3.97 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 31.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 31.75, "10th_percentile": 31.75, "90th_percentile": 31.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 31.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 31.75, "10th_percentile": 31.75, "90th_percentile": 31.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 31.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 31.75, "10th_percentile": 31.75, "90th_percentile": 31.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 31.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 31.75, "10th_percentile": 31.75, "90th_percentile": 31.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 31.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 31.75, "10th_percentile": 31.75, "90th_percentile": 31.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 17.84, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 17.84, "10th_percentile": 17.84, "90th_percentile": 17.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 14.92, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 14.92, "10th_percentile": 14.92, "90th_percentile": 14.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 13.34, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 13.34, "10th_percentile": 13.34, "90th_percentile": 13.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 18.55, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.55, "10th_percentile": 18.55, "90th_percentile": 18.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 19.49, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 19.49, "10th_percentile": 19.49, "90th_percentile": 19.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 15.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 15.88, "10th_percentile": 15.88, "90th_percentile": 15.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 19.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 19.05, "10th_percentile": 19.05, "90th_percentile": 19.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH AETNA", "standard_charge_dollar": 17.84, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 17.84, "10th_percentile": 17.84, "90th_percentile": 17.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 21.24, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.24, "10th_percentile": 21.24, "90th_percentile": 21.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 27.62, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 27.62, "10th_percentile": 27.62, "90th_percentile": 27.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 20.0, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 20.0, "10th_percentile": 20.0, "90th_percentile": 20.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 19.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 19.05, "10th_percentile": 19.05, "90th_percentile": 19.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 20.64, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 20.64, "10th_percentile": 20.64, "90th_percentile": 20.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 19.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 19.05, "10th_percentile": 19.05, "90th_percentile": 19.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 13.34, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 13.34, "10th_percentile": 13.34, "90th_percentile": 13.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 25.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 25.4, "10th_percentile": 25.4, "90th_percentile": 25.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 17.26, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 17.26, "10th_percentile": 17.26, "90th_percentile": 17.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 15.43, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15.43, "10th_percentile": 15.43, "90th_percentile": 15.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 15.4, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15.4, "10th_percentile": 15.4, "90th_percentile": 15.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 20.64, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 20.64, "10th_percentile": 20.64, "90th_percentile": 20.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 19.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 19.05, "10th_percentile": 19.05, "90th_percentile": 19.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 19.49, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 19.49, "10th_percentile": 19.49, "90th_percentile": 19.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 17.75, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 17.75, "10th_percentile": 17.75, "90th_percentile": 17.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 18.55, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.55, "10th_percentile": 18.55, "90th_percentile": 18.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 20.64, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 20.64, "10th_percentile": 20.64, "90th_percentile": 20.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 19.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 19.05, "10th_percentile": 19.05, "90th_percentile": 19.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 17.3, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 17.3, "10th_percentile": 17.3, "90th_percentile": 17.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 17.3, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 17.3, "10th_percentile": 17.3, "90th_percentile": 17.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 17.3, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 17.3, "10th_percentile": 17.3, "90th_percentile": 17.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" } ] } ] }, { "description": "ENOXAPARIN 40 MG SUBQ SYRG", "drug_information": { "unit": 0.4, "type": "ML" }, "code_information": [ { "code": "RX-90211", "type": "CDM" }, { "code": "J1650", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00955-1004-10", "type": "NDC" } ], "standard_charges": [ { "minimum": 13.34, "maximum": 31.75, "setting": "outpatient", "gross_charge": 31.75, "discounted_cash": 22.22, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $31.75 @ 12.5% = $3.97 due to $0.00 Claim Price", "median_amount": 3.97, "10th_percentile": 3.97, "90th_percentile": 3.97, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $31.75 @ 12.5% = $3.97 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $31.75 @ 12.5% = $3.97 due to $0.00 Claim Price", "median_amount": 3.97, "10th_percentile": 3.97, "90th_percentile": 3.97, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $31.75 @ 12.5% = $3.97 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $31.75 @ 12.5% = $3.97 due to $0.00 Claim Price", "median_amount": 3.97, "10th_percentile": 3.97, "90th_percentile": 3.97, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $31.75 @ 12.5% = $3.97 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 20.64, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 20.64, "10th_percentile": 20.64, "90th_percentile": 20.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 19.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 19.05, "10th_percentile": 19.05, "90th_percentile": 19.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 19.49, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 19.49, "10th_percentile": 19.49, "90th_percentile": 19.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 17.75, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 17.75, "10th_percentile": 17.75, "90th_percentile": 17.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 18.55, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.55, "10th_percentile": 18.55, "90th_percentile": 18.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 20.64, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 20.64, "10th_percentile": 20.64, "90th_percentile": 20.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 19.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 19.05, "10th_percentile": 19.05, "90th_percentile": 19.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 17.3, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 17.3, "10th_percentile": 17.3, "90th_percentile": 17.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 17.3, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 17.3, "10th_percentile": 17.3, "90th_percentile": 17.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 17.3, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 17.3, "10th_percentile": 17.3, "90th_percentile": 17.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 31.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 31.75, "10th_percentile": 31.75, "90th_percentile": 31.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 31.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 31.75, "10th_percentile": 31.75, "90th_percentile": 31.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 31.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 31.75, "10th_percentile": 31.75, "90th_percentile": 31.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 31.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 31.75, "10th_percentile": 31.75, "90th_percentile": 31.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 31.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 31.75, "10th_percentile": 31.75, "90th_percentile": 31.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 17.84, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 17.84, "10th_percentile": 17.84, "90th_percentile": 17.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 14.92, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 14.92, "10th_percentile": 14.92, "90th_percentile": 14.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 13.34, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 13.34, "10th_percentile": 13.34, "90th_percentile": 13.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 18.55, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.55, "10th_percentile": 18.55, "90th_percentile": 18.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 19.49, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 19.49, "10th_percentile": 19.49, "90th_percentile": 19.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 15.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 15.88, "10th_percentile": 15.88, "90th_percentile": 15.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 19.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 19.05, "10th_percentile": 19.05, "90th_percentile": 19.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH AETNA", "standard_charge_dollar": 17.84, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 17.84, "10th_percentile": 17.84, "90th_percentile": 17.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 21.24, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.24, "10th_percentile": 21.24, "90th_percentile": 21.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 27.62, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 27.62, "10th_percentile": 27.62, "90th_percentile": 27.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 20.0, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 20.0, "10th_percentile": 20.0, "90th_percentile": 20.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 19.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 19.05, "10th_percentile": 19.05, "90th_percentile": 19.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 20.64, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 20.64, "10th_percentile": 20.64, "90th_percentile": 20.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 19.05, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 19.05, "10th_percentile": 19.05, "90th_percentile": 19.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 13.34, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 13.34, "10th_percentile": 13.34, "90th_percentile": 13.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 25.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 25.4, "10th_percentile": 25.4, "90th_percentile": 25.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 17.26, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 17.26, "10th_percentile": 17.26, "90th_percentile": 17.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 15.43, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15.43, "10th_percentile": 15.43, "90th_percentile": 15.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 15.4, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15.4, "10th_percentile": 15.4, "90th_percentile": 15.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "ENOXAPARIN 80 MG SUBQ SYRG", "drug_information": { "unit": 0.8, "type": "ML" }, "code_information": [ { "code": "RX-90209", "type": "CDM" }, { "code": "J1650", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00955-1008-10", "type": "NDC" } ], "standard_charges": [ { "minimum": 32.66, "maximum": 77.75, "setting": "outpatient", "gross_charge": 77.75, "discounted_cash": 54.42, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $77.75 @ 12.5% = $9.72 due to $0.00 Claim Price", "median_amount": 9.72, "10th_percentile": 9.72, "90th_percentile": 9.72, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $77.75 @ 12.5% = $9.72 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $77.75 @ 12.5% = $9.72 due to $0.00 Claim Price", "median_amount": 9.72, "10th_percentile": 9.72, "90th_percentile": 9.72, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $77.75 @ 12.5% = $9.72 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $77.75 @ 12.5% = $9.72 due to $0.00 Claim Price", "median_amount": 9.72, "10th_percentile": 9.72, "90th_percentile": 9.72, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $77.75 @ 12.5% = $9.72 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 50.54, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 50.54, "10th_percentile": 50.54, "90th_percentile": 50.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 46.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 46.65, "10th_percentile": 46.65, "90th_percentile": 46.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 47.74, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 47.74, "10th_percentile": 47.74, "90th_percentile": 47.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 43.46, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 43.46, "10th_percentile": 43.46, "90th_percentile": 43.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 45.44, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.44, "10th_percentile": 45.44, "90th_percentile": 45.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 50.54, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 50.54, "10th_percentile": 50.54, "90th_percentile": 50.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 46.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 46.65, "10th_percentile": 46.65, "90th_percentile": 46.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 42.37, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 42.37, "10th_percentile": 42.37, "90th_percentile": 42.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 42.37, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 42.37, "10th_percentile": 42.37, "90th_percentile": 42.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 42.37, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 42.37, "10th_percentile": 42.37, "90th_percentile": 42.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 77.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 77.75, "10th_percentile": 77.75, "90th_percentile": 77.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 77.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 77.75, "10th_percentile": 77.75, "90th_percentile": 77.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 77.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 77.75, "10th_percentile": 77.75, "90th_percentile": 77.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 77.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 77.75, "10th_percentile": 77.75, "90th_percentile": 77.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 77.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 77.75, "10th_percentile": 77.75, "90th_percentile": 77.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 43.7, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 43.7, "10th_percentile": 43.7, "90th_percentile": 43.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 36.54, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% 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; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 32.66, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 32.66, "10th_percentile": 32.66, "90th_percentile": 32.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 45.44, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.44, "10th_percentile": 45.44, "90th_percentile": 45.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 47.74, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 47.74, "10th_percentile": 47.74, "90th_percentile": 47.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 38.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 38.88, "10th_percentile": 38.88, "90th_percentile": 38.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 46.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 46.65, "10th_percentile": 46.65, "90th_percentile": 46.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH AETNA", "standard_charge_dollar": 43.7, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 43.7, "10th_percentile": 43.7, "90th_percentile": 43.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 52.01, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 52.01, "10th_percentile": 52.01, "90th_percentile": 52.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 67.64, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 67.64, "10th_percentile": 67.64, "90th_percentile": 67.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 48.98, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 48.98, "10th_percentile": 48.98, "90th_percentile": 48.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 46.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 46.65, "10th_percentile": 46.65, "90th_percentile": 46.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 50.54, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 50.54, "10th_percentile": 50.54, "90th_percentile": 50.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 46.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 46.65, "10th_percentile": 46.65, "90th_percentile": 46.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 32.66, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 32.66, "10th_percentile": 32.66, "90th_percentile": 32.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 62.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 62.2, "10th_percentile": 62.2, "90th_percentile": 62.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 42.26, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 42.26, "10th_percentile": 42.26, "90th_percentile": 42.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 37.79, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 37.79, "10th_percentile": 37.79, "90th_percentile": 37.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 37.71, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 37.71, "10th_percentile": 37.71, "90th_percentile": 37.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "ENOXAPARIN 150 MG SUBQ SYRG", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "RX-87303", "type": "CDM" }, { "code": "J1650", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00075-8025-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 64.68, "maximum": 154.0, "setting": "outpatient", "gross_charge": 154.0, "discounted_cash": 107.8, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 83.93, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 83.93, "10th_percentile": 83.93, "90th_percentile": 83.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 83.93, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 83.93, "10th_percentile": 83.93, "90th_percentile": 83.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 83.93, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 83.93, "10th_percentile": 83.93, "90th_percentile": 83.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 90.0, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 90.0, "10th_percentile": 90.0, "90th_percentile": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 86.09, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 86.09, "10th_percentile": 86.09, "90th_percentile": 86.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 94.56, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 94.56, "10th_percentile": 94.56, "90th_percentile": 94.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 92.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 92.4, "10th_percentile": 92.4, "90th_percentile": 92.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 100.1, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 100.1, "10th_percentile": 100.1, "90th_percentile": 100.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 100.1, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 100.1, "10th_percentile": 100.1, "90th_percentile": 100.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 92.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 92.4, "10th_percentile": 92.4, "90th_percentile": 92.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 154.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 154.0, "10th_percentile": 154.0, "90th_percentile": 154.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 154.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 154.0, "10th_percentile": 154.0, "90th_percentile": 154.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 154.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 154.0, "10th_percentile": 154.0, "90th_percentile": 154.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 154.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 154.0, "10th_percentile": 154.0, "90th_percentile": 154.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 154.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 154.0, "10th_percentile": 154.0, "90th_percentile": 154.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 86.55, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 86.55, "10th_percentile": 86.55, "90th_percentile": 86.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 72.38, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 72.38, "10th_percentile": 72.38, "90th_percentile": 72.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 64.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 64.68, "10th_percentile": 64.68, "90th_percentile": 64.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 90.0, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 90.0, "10th_percentile": 90.0, "90th_percentile": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 94.56, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 94.56, "10th_percentile": 94.56, "90th_percentile": 94.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 77.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 77.0, "10th_percentile": 77.0, "90th_percentile": 77.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 92.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 92.4, "10th_percentile": 92.4, "90th_percentile": 92.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH AETNA", "standard_charge_dollar": 86.55, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 86.55, "10th_percentile": 86.55, "90th_percentile": 86.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 103.03, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 103.03, "10th_percentile": 103.03, "90th_percentile": 103.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 133.98, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 133.98, "10th_percentile": 133.98, "90th_percentile": 133.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 97.02, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 97.02, "10th_percentile": 97.02, "90th_percentile": 97.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 92.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 92.4, "10th_percentile": 92.4, "90th_percentile": 92.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 100.1, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 100.1, "10th_percentile": 100.1, "90th_percentile": 100.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 92.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 92.4, "10th_percentile": 92.4, "90th_percentile": 92.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 64.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 64.68, "10th_percentile": 64.68, "90th_percentile": 64.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 123.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 123.2, "10th_percentile": 123.2, "90th_percentile": 123.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 83.7, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 83.7, "10th_percentile": 83.7, "90th_percentile": 83.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 74.84, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 74.84, "10th_percentile": 74.84, "90th_percentile": 74.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 74.69, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 74.69, "10th_percentile": 74.69, "90th_percentile": 74.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $154.00 @ 12.5% = $19.25 due to $0.00 Claim Price", "median_amount": 19.25, "10th_percentile": 19.25, "90th_percentile": 19.25, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $154.00 @ 12.5% = $19.25 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $154.00 @ 12.5% = $19.25 due to $0.00 Claim Price", "median_amount": 19.25, "10th_percentile": 19.25, "90th_percentile": 19.25, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $154.00 @ 12.5% = $19.25 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $154.00 @ 12.5% = $19.25 due to $0.00 Claim Price", "median_amount": 19.25, "10th_percentile": 19.25, "90th_percentile": 19.25, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $154.00 @ 12.5% = $19.25 due to $0.00 Claim Price" } ] } ] }, { "description": "ENOXAPARIN 150 MG SUBQ SYRG", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "RX-87303", "type": "CDM" }, { "code": "J1650", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00075-8025-10", "type": "NDC" } ], "standard_charges": [ { "minimum": 64.68, "maximum": 154.0, "setting": "outpatient", "gross_charge": 154.0, "discounted_cash": 107.8, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 154.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 154.0, "10th_percentile": 154.0, "90th_percentile": 154.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 154.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 154.0, "10th_percentile": 154.0, "90th_percentile": 154.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 154.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 154.0, "10th_percentile": 154.0, "90th_percentile": 154.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 154.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 154.0, "10th_percentile": 154.0, "90th_percentile": 154.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 154.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 154.0, "10th_percentile": 154.0, "90th_percentile": 154.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 86.55, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 86.55, "10th_percentile": 86.55, "90th_percentile": 86.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 72.38, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 72.38, "10th_percentile": 72.38, "90th_percentile": 72.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 64.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 64.68, "10th_percentile": 64.68, "90th_percentile": 64.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 90.0, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 90.0, "10th_percentile": 90.0, "90th_percentile": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 94.56, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 94.56, "10th_percentile": 94.56, "90th_percentile": 94.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 77.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 77.0, "10th_percentile": 77.0, "90th_percentile": 77.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 92.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 92.4, "10th_percentile": 92.4, "90th_percentile": 92.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH AETNA", "standard_charge_dollar": 86.55, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 86.55, "10th_percentile": 86.55, "90th_percentile": 86.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 103.03, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 103.03, "10th_percentile": 103.03, "90th_percentile": 103.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 133.98, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 133.98, "10th_percentile": 133.98, "90th_percentile": 133.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 97.02, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 97.02, "10th_percentile": 97.02, "90th_percentile": 97.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 92.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 92.4, "10th_percentile": 92.4, "90th_percentile": 92.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 100.1, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 100.1, "10th_percentile": 100.1, "90th_percentile": 100.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 92.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 92.4, "10th_percentile": 92.4, "90th_percentile": 92.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 64.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 64.68, "10th_percentile": 64.68, "90th_percentile": 64.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 123.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 123.2, "10th_percentile": 123.2, "90th_percentile": 123.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 83.7, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 83.7, "10th_percentile": 83.7, "90th_percentile": 83.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 74.84, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 74.84, "10th_percentile": 74.84, "90th_percentile": 74.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 74.69, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 74.69, "10th_percentile": 74.69, "90th_percentile": 74.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 83.93, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 83.93, "10th_percentile": 83.93, "90th_percentile": 83.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 83.93, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 83.93, "10th_percentile": 83.93, "90th_percentile": 83.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 83.93, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 83.93, "10th_percentile": 83.93, "90th_percentile": 83.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 90.0, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 90.0, "10th_percentile": 90.0, "90th_percentile": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 86.09, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 86.09, "10th_percentile": 86.09, "90th_percentile": 86.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 94.56, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 94.56, "10th_percentile": 94.56, "90th_percentile": 94.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 92.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 92.4, "10th_percentile": 92.4, "90th_percentile": 92.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 100.1, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 100.1, "10th_percentile": 100.1, "90th_percentile": 100.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 100.1, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 100.1, "10th_percentile": 100.1, "90th_percentile": 100.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 92.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 92.4, "10th_percentile": 92.4, "90th_percentile": 92.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $154.00 @ 12.5% = $19.25 due to $0.00 Claim Price", "median_amount": 19.25, "10th_percentile": 19.25, "90th_percentile": 19.25, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $154.00 @ 12.5% = $19.25 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $154.00 @ 12.5% = $19.25 due to $0.00 Claim Price", "median_amount": 19.25, "10th_percentile": 19.25, "90th_percentile": 19.25, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $154.00 @ 12.5% = $19.25 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $154.00 @ 12.5% = $19.25 due to $0.00 Claim Price", "median_amount": 19.25, "10th_percentile": 19.25, "90th_percentile": 19.25, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $154.00 @ 12.5% = $19.25 due to $0.00 Claim Price" } ] } ] }, { "description": "EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-42184", "type": "CDM" }, { "code": "J0165", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00093-5986-19", "type": "NDC" } ], "standard_charges": [ { "minimum": 851.87, "maximum": 2028.25, "setting": "outpatient", "gross_charge": 2028.25, "discounted_cash": 1419.77, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2028.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2028.25, "10th_percentile": 2028.25, "90th_percentile": 2028.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2028.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2028.25, "10th_percentile": 2028.25, "90th_percentile": 2028.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2028.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2028.25, "10th_percentile": 2028.25, "90th_percentile": 2028.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2028.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2028.25, "10th_percentile": 2028.25, "90th_percentile": 2028.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2028.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2028.25, "10th_percentile": 2028.25, "90th_percentile": 2028.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 1318.36, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 1318.36, "10th_percentile": 1318.36, "90th_percentile": 1318.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 1277.8, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 1277.8, "10th_percentile": 1277.8, "90th_percentile": 1277.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 1764.58, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 1764.58, "10th_percentile": 1764.58, "90th_percentile": 1764.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 1622.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 1622.6, "10th_percentile": 1622.6, "90th_percentile": 1622.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 1356.9, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1356.9, "10th_percentile": 1356.9, "90th_percentile": 1356.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 983.7, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 983.7, "10th_percentile": 983.7, "90th_percentile": 983.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 1014.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 1014.13, "10th_percentile": 1014.13, "90th_percentile": 1014.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1185.31, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1185.31, "10th_percentile": 1185.31, "90th_percentile": 1185.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH THE ALLIANCE", "standard_charge_dollar": 1102.35, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 1102.35, "10th_percentile": 1102.35, "90th_percentile": 1102.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 985.73, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 985.73, "10th_percentile": 985.73, "90th_percentile": 985.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 953.28, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 953.28, "10th_percentile": 953.28, "90th_percentile": 953.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 1245.35, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 1245.35, "10th_percentile": 1245.35, "90th_percentile": 1245.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH AETNA", "standard_charge_dollar": 1139.88, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883; Note: Daily limit of $883.00 reached for 02/02/26.", "median_amount": 883.0, "10th_percentile": 883.0, "90th_percentile": 883.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883; Note: Daily limit of $883.00 reached for 02/02/26." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 1139.88, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883; Note: Daily limit of $883.00 reached for 02/02/26.", "median_amount": 883.0, "10th_percentile": 883.0, "90th_percentile": 883.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883; Note: Daily limit of $883.00 reached for 02/02/26." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1216.95, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 1216.95, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1216.95, "10th_percentile": 1216.95, "90th_percentile": 1216.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 1216.95, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1216.95, "10th_percentile": 1216.95, "90th_percentile": 1216.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 851.87, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 851.87, "10th_percentile": 851.87, "90th_percentile": 851.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 851.87, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 851.87, "10th_percentile": 851.87, "90th_percentile": 851.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1105.4, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 1105.4, "10th_percentile": 1105.4, "90th_percentile": 1105.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1105.4, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 1105.4, "10th_percentile": 1105.4, "90th_percentile": 1105.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1105.4, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 1105.4, "10th_percentile": 1105.4, "90th_percentile": 1105.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1133.79, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 1133.79, "10th_percentile": 1133.79, "90th_percentile": 1133.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 1216.95, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1216.95, "10th_percentile": 1216.95, "90th_percentile": 1216.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 1318.36, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 1318.36, "10th_percentile": 1318.36, "90th_percentile": 1318.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1185.31, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1185.31, "10th_percentile": 1185.31, "90th_percentile": 1185.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 1245.35, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 1245.35, "10th_percentile": 1245.35, "90th_percentile": 1245.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 1318.36, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1216.95, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,028.25 @ 12.5% = $253.53 due to $0.00 Claim Price", "median_amount": 253.53, "10th_percentile": 253.53, "90th_percentile": 253.53, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,028.25 @ 12.5% = $253.53 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,028.25 @ 12.5% = $253.53 due to $0.00 Claim Price", "median_amount": 253.53, "10th_percentile": 253.53, "90th_percentile": 253.53, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,028.25 @ 12.5% = $253.53 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,028.25 @ 12.5% = $253.53 due to $0.00 Claim Price", "median_amount": 253.53, "10th_percentile": 253.53, "90th_percentile": 253.53, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,028.25 @ 12.5% = $253.53 due to $0.00 Claim Price" } ] } ] }, { "description": "ESTRADIOL 0.025 MG/24 HR TRANSDERM PTSW", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-88440", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00378-4644-26", "type": "NDC" } ], "standard_charges": [ { "minimum": 51.56, "maximum": 122.75, "setting": "outpatient", "gross_charge": 122.75, "discounted_cash": 85.92, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 79.79, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 79.79, "10th_percentile": 79.79, "90th_percentile": 79.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 73.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 73.65, "10th_percentile": 73.65, "90th_percentile": 73.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 68.62, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 68.62, "10th_percentile": 68.62, "90th_percentile": 68.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 71.74, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 71.74, "10th_percentile": 71.74, "90th_percentile": 71.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 70.8, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 70.8, "10th_percentile": 70.8, "90th_percentile": 70.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 79.79, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 79.79, "10th_percentile": 79.79, "90th_percentile": 79.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 62.55, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 62.55, "10th_percentile": 62.55, "90th_percentile": 62.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 73.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 73.65, "10th_percentile": 73.65, "90th_percentile": 73.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 59.57, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 59.57, "10th_percentile": 59.57, "90th_percentile": 59.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 59.57, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 59.57, "10th_percentile": 59.57, "90th_percentile": 59.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 57.69, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 57.69, "10th_percentile": 57.69, "90th_percentile": 57.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 71.74, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 71.74, "10th_percentile": 71.74, "90th_percentile": 71.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 70.8, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 70.8, "10th_percentile": 70.8, "90th_percentile": 70.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 61.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 61.38, "10th_percentile": 61.38, "90th_percentile": 61.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 82.12, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 82.12, "10th_percentile": 82.12, "90th_percentile": 82.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 106.79, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 106.79, "10th_percentile": 106.79, "90th_percentile": 106.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 77.33, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 77.33, "10th_percentile": 77.33, "90th_percentile": 77.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 79.79, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 79.79, "10th_percentile": 79.79, "90th_percentile": 79.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 98.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 98.2, "10th_percentile": 98.2, "90th_percentile": 98.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 66.71, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 66.71, "10th_percentile": 66.71, "90th_percentile": 66.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 59.66, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.66, "10th_percentile": 59.66, "90th_percentile": 59.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 59.53, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.53, "10th_percentile": 59.53, "90th_percentile": 59.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 73.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 73.65, "10th_percentile": 73.65, "90th_percentile": 73.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 73.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 73.65, "10th_percentile": 73.65, "90th_percentile": 73.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 73.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 73.65, "10th_percentile": 73.65, "90th_percentile": 73.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 51.56, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 51.56, "10th_percentile": 51.56, "90th_percentile": 51.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 51.56, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 51.56, "10th_percentile": 51.56, "90th_percentile": 51.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 122.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 122.75, "10th_percentile": 122.75, "90th_percentile": 122.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 122.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 122.75, "10th_percentile": 122.75, "90th_percentile": 122.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 122.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 122.75, "10th_percentile": 122.75, "90th_percentile": 122.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 122.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 122.75, "10th_percentile": 122.75, "90th_percentile": 122.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 122.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 122.75, "10th_percentile": 122.75, "90th_percentile": 122.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 122.75, "10th_percentile": 122.75, "90th_percentile": 122.75, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 122.75, "10th_percentile": 122.75, "90th_percentile": 122.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 122.75, "10th_percentile": 122.75, "90th_percentile": 122.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ESTRADIOL 0.05 MG/24 HR TRANSDERM PTSW", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-27459", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00781-7144-58", "type": "NDC" } ], "standard_charges": [ { "minimum": 50.72, "maximum": 120.75, "setting": "outpatient", "gross_charge": 120.75, "discounted_cash": 84.52, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 78.49, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 78.49, "10th_percentile": 78.49, "90th_percentile": 78.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 72.45, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 72.45, "10th_percentile": 72.45, "90th_percentile": 72.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 67.5, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 67.5, "10th_percentile": 67.5, "90th_percentile": 67.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 70.57, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 70.57, "10th_percentile": 70.57, "90th_percentile": 70.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 69.65, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 69.65, "10th_percentile": 69.65, "90th_percentile": 69.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 78.49, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 78.49, "10th_percentile": 78.49, "90th_percentile": 78.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 61.53, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 61.53, "10th_percentile": 61.53, "90th_percentile": 61.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 72.45, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 72.45, "10th_percentile": 72.45, "90th_percentile": 72.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 58.6, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 58.6, "10th_percentile": 58.6, "90th_percentile": 58.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 58.6, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 58.6, "10th_percentile": 58.6, "90th_percentile": 58.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 56.75, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 56.75, "10th_percentile": 56.75, "90th_percentile": 56.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 70.57, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 70.57, "10th_percentile": 70.57, "90th_percentile": 70.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 69.65, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 69.65, "10th_percentile": 69.65, "90th_percentile": 69.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 60.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 60.38, "10th_percentile": 60.38, "90th_percentile": 60.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 80.78, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 80.78, "10th_percentile": 80.78, "90th_percentile": 80.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 105.05, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 105.05, "10th_percentile": 105.05, "90th_percentile": 105.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 76.07, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 76.07, "10th_percentile": 76.07, "90th_percentile": 76.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 78.49, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 78.49, "10th_percentile": 78.49, "90th_percentile": 78.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 96.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 96.6, "10th_percentile": 96.6, "90th_percentile": 96.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 65.63, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 65.63, "10th_percentile": 65.63, "90th_percentile": 65.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 58.68, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 58.68, "10th_percentile": 58.68, "90th_percentile": 58.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 58.56, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 58.56, "10th_percentile": 58.56, "90th_percentile": 58.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 72.45, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 72.45, "10th_percentile": 72.45, "90th_percentile": 72.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 72.45, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 72.45, "10th_percentile": 72.45, "90th_percentile": 72.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 72.45, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 72.45, "10th_percentile": 72.45, "90th_percentile": 72.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 50.72, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 50.72, "10th_percentile": 50.72, "90th_percentile": 50.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 50.72, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 50.72, "10th_percentile": 50.72, "90th_percentile": 50.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 120.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 120.75, "10th_percentile": 120.75, "90th_percentile": 120.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 120.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 120.75, "10th_percentile": 120.75, "90th_percentile": 120.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 120.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 120.75, "10th_percentile": 120.75, "90th_percentile": 120.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 120.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 120.75, "10th_percentile": 120.75, "90th_percentile": 120.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 120.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 120.75, "10th_percentile": 120.75, "90th_percentile": 120.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 120.75, "10th_percentile": 120.75, "90th_percentile": 120.75, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 120.75, "10th_percentile": 120.75, "90th_percentile": 120.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 120.75, "10th_percentile": 120.75, "90th_percentile": 120.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "EZETIMIBE 5 MG ORAL HALF TAB", "drug_information": { "unit": 5.0, "type": "ME" }, "code_information": [ { "code": "RX-4080000032", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00000-0100-32", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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" } ] } ] }, { "description": "FAMOTIDINE (PF) 20 MG/2 ML IV SOLN", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "RX-102681", "type": "CDM" }, { "code": "J1308", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00641-6022-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 3.26, "maximum": 7.75, "setting": "outpatient", "gross_charge": 7.75, "discounted_cash": 5.42, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7.75 @ 12.5% = $0.97 due to $0.00 Claim Price", "median_amount": 0.97, "10th_percentile": 0.97, "90th_percentile": 0.97, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7.75 @ 12.5% = $0.97 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7.75 @ 12.5% = $0.97 due to $0.00 Claim Price", "median_amount": 0.97, "10th_percentile": 0.97, "90th_percentile": 0.97, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7.75 @ 12.5% = $0.97 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7.75 @ 12.5% = $0.97 due to $0.00 Claim Price", "median_amount": 0.97, "10th_percentile": 0.97, "90th_percentile": 0.97, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7.75 @ 12.5% = $0.97 due to $0.00 Claim Price" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_algorithm": "No contract line matched", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 4.36, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 4.36, "10th_percentile": 4.36, "90th_percentile": 4.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 3.64, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 3.64, "10th_percentile": 3.64, "90th_percentile": 3.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 3.26, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 3.26, "10th_percentile": 3.26, "90th_percentile": 3.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 4.53, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.53, "10th_percentile": 4.53, "90th_percentile": 4.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 4.76, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 4.76, "10th_percentile": 4.76, "90th_percentile": 4.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 3.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 3.88, "10th_percentile": 3.88, "90th_percentile": 3.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 4.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.65, "10th_percentile": 4.65, "90th_percentile": 4.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH AETNA", "standard_charge_dollar": 4.36, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 4.36, "10th_percentile": 4.36, "90th_percentile": 4.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 5.18, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.18, "10th_percentile": 5.18, "90th_percentile": 5.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 6.74, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 6.74, "10th_percentile": 6.74, "90th_percentile": 6.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 4.88, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 4.88, "10th_percentile": 4.88, "90th_percentile": 4.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 4.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 4.65, "10th_percentile": 4.65, "90th_percentile": 4.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 5.04, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 5.04, "10th_percentile": 5.04, "90th_percentile": 5.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 4.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 4.65, "10th_percentile": 4.65, "90th_percentile": 4.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 3.26, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 3.26, "10th_percentile": 3.26, "90th_percentile": 3.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 6.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 6.2, "10th_percentile": 6.2, "90th_percentile": 6.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 4.21, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 4.21, "10th_percentile": 4.21, "90th_percentile": 4.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 3.77, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.77, "10th_percentile": 3.77, "90th_percentile": 3.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 4.22, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 4.22, "10th_percentile": 4.22, "90th_percentile": 4.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 4.22, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 4.22, "10th_percentile": 4.22, "90th_percentile": 4.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 4.22, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 4.22, "10th_percentile": 4.22, "90th_percentile": 4.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 4.33, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 4.33, "10th_percentile": 4.33, "90th_percentile": 4.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 4.53, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.53, "10th_percentile": 4.53, "90th_percentile": 4.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 5.04, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 5.04, "10th_percentile": 5.04, "90th_percentile": 5.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 4.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 4.65, "10th_percentile": 4.65, "90th_percentile": 4.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 4.76, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 4.76, "10th_percentile": 4.76, "90th_percentile": 4.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 4.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 4.65, "10th_percentile": 4.65, "90th_percentile": 4.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 5.04, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 5.04, "10th_percentile": 5.04, "90th_percentile": 5.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" } ] } ] }, { "description": "FAMOTIDINE 20 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-10011", "type": "CDM" }, { "code": "J8499", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "16837-0855-25", "type": "NDC" } ], "standard_charges": [ { "minimum": 2.7, "maximum": 5.75, "setting": "outpatient", "gross_charge": 5.75, "discounted_cash": 4.02, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2.7, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2.7, "10th_percentile": 2.7, "90th_percentile": 2.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3.36, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.36, "10th_percentile": 3.36, "90th_percentile": 3.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 3.53, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3.53, "10th_percentile": 3.53, "90th_percentile": 3.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3.13, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3.13, "10th_percentile": 3.13, "90th_percentile": 3.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 3.13, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3.13, "10th_percentile": 3.13, "90th_percentile": 3.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 3.13, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3.13, "10th_percentile": 3.13, "90th_percentile": 3.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3.36, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.36, "10th_percentile": 3.36, "90th_percentile": 3.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3.21, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 3.21, "10th_percentile": 3.21, "90th_percentile": 3.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3.53, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3.53, "10th_percentile": 3.53, "90th_percentile": 3.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.88, "10th_percentile": 2.88, "90th_percentile": 2.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 3.45, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 3.13, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 3.13, "10th_percentile": 3.13, "90th_percentile": 3.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5.75 @ 12.5% = $0.72 due to $0.00 Claim Price", "median_amount": 0.72, "10th_percentile": 0.72, "90th_percentile": 0.72, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5.75 @ 12.5% = $0.72 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5.75 @ 12.5% = $0.72 due to $0.00 Claim Price", "median_amount": 0.72, "10th_percentile": 0.72, "90th_percentile": 0.72, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5.75 @ 12.5% = $0.72 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5.75 @ 12.5% = $0.72 due to $0.00 Claim Price", "median_amount": 0.72, "10th_percentile": 0.72, "90th_percentile": 0.72, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5.75 @ 12.5% = $0.72 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_algorithm": "No contract line matched", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_algorithm": "No contract line matched", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_algorithm": "No contract line matched", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH AETNA", "standard_charge_algorithm": "No contract line matched", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_algorithm": "No contract line matched", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_algorithm": "No contract line matched", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_algorithm": "No contract line matched", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_algorithm": "No contract line matched", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_algorithm": "No contract line matched", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_algorithm": "No contract line matched", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_algorithm": "No contract line matched", "median_amount": 5.75, "10th_percentile": 5.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" } ] } ] }, { "description": "FENOFIBRATE 54 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-175553", "type": "CDM" }, { "code": "25000000", "type": "LOCAL" }, { "code": "0250", "type": "RC" }, { "code": "63304-0900-90", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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" } ] } ] }, { "description": "FENOFIBRATE 160 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-98886", "type": "CDM" }, { "code": "25000000", "type": "LOCAL" }, { "code": "0250", "type": "RC" }, { "code": "42858-0660-45", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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" } ] } ] }, { "description": "FENTANYL 50 MCG/HR TRANSDERM PT72", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-27906", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "47781-0426-47", "type": "NDC" } ], "standard_charges": [ { "minimum": 39.27, "maximum": 93.5, "setting": "outpatient", "gross_charge": 93.5, "discounted_cash": 65.45, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 60.78, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 60.78, "10th_percentile": 60.78, "90th_percentile": 60.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 56.1, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 56.1, "10th_percentile": 56.1, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 52.27, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 52.27, "10th_percentile": 52.27, "90th_percentile": 52.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 54.64, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 54.64, "10th_percentile": 54.64, "90th_percentile": 54.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 53.93, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 53.93, "10th_percentile": 53.93, "90th_percentile": 53.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 60.78, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 60.78, "10th_percentile": 60.78, "90th_percentile": 60.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 47.65, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 47.65, "10th_percentile": 47.65, "90th_percentile": 47.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 56.1, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 56.1, "10th_percentile": 56.1, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 45.38, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 45.38, "10th_percentile": 45.38, "90th_percentile": 45.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 45.38, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 45.38, "10th_percentile": 45.38, "90th_percentile": 45.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 43.95, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 43.95, "10th_percentile": 43.95, "90th_percentile": 43.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 54.64, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 54.64, "10th_percentile": 54.64, "90th_percentile": 54.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 53.93, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 53.93, "10th_percentile": 53.93, "90th_percentile": 53.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 46.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 46.75, "10th_percentile": 46.75, "90th_percentile": 46.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 62.55, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 62.55, "10th_percentile": 62.55, "90th_percentile": 62.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 81.35, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 81.35, "10th_percentile": 81.35, "90th_percentile": 81.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 58.91, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 58.91, "10th_percentile": 58.91, "90th_percentile": 58.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 60.78, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 60.78, "10th_percentile": 60.78, "90th_percentile": 60.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 74.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 74.8, "10th_percentile": 74.8, "90th_percentile": 74.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 50.82, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 50.82, "10th_percentile": 50.82, "90th_percentile": 50.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 45.44, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.44, "10th_percentile": 45.44, "90th_percentile": 45.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 45.35, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.35, "10th_percentile": 45.35, "90th_percentile": 45.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 56.1, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 56.1, "10th_percentile": 56.1, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 56.1, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 56.1, "10th_percentile": 56.1, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 56.1, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 56.1, "10th_percentile": 56.1, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 39.27, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 39.27, "10th_percentile": 39.27, "90th_percentile": 39.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 39.27, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 39.27, "10th_percentile": 39.27, "90th_percentile": 39.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 93.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 93.5, "10th_percentile": 93.5, "90th_percentile": 93.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 93.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 93.5, "10th_percentile": 93.5, "90th_percentile": 93.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 93.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 93.5, "10th_percentile": 93.5, "90th_percentile": 93.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 93.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 93.5, "10th_percentile": 93.5, "90th_percentile": 93.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 93.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 93.5, "10th_percentile": 93.5, "90th_percentile": 93.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 93.5, "10th_percentile": 93.5, "90th_percentile": 93.5, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 93.5, "10th_percentile": 93.5, "90th_percentile": 93.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 93.5, "10th_percentile": 93.5, "90th_percentile": 93.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "FERROUS SULFATE 137 MG (45 MG IRON) ORAL TBER", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-242988", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "86790-0019-30", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.84, "maximum": 2.0, "setting": "outpatient", "gross_charge": 2.0, "discounted_cash": 1.4, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 1.3, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 1.3, "10th_percentile": 1.3, "90th_percentile": 1.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 1.2, "10th_percentile": 1.2, "90th_percentile": 1.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1.12, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 1.12, "10th_percentile": 1.12, "90th_percentile": 1.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1.17, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.17, "10th_percentile": 1.17, "90th_percentile": 1.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 1.15, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 1.15, "10th_percentile": 1.15, "90th_percentile": 1.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 1.3, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 1.3, "10th_percentile": 1.3, "90th_percentile": 1.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1.02, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 1.02, "10th_percentile": 1.02, "90th_percentile": 1.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 1.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1.2, "10th_percentile": 1.2, "90th_percentile": 1.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 0.97, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 0.97, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.94, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 0.94, "10th_percentile": 0.94, "90th_percentile": 0.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1.17, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.17, "10th_percentile": 1.17, "90th_percentile": 1.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 1.15, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 1.15, "10th_percentile": 1.15, "90th_percentile": 1.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 1.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 1.34, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.34, "10th_percentile": 1.34, "90th_percentile": 1.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 1.74, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 1.74, "10th_percentile": 1.74, "90th_percentile": 1.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 1.26, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 1.26, "10th_percentile": 1.26, "90th_percentile": 1.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 1.3, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 1.3, "10th_percentile": 1.3, "90th_percentile": 1.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 1.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 1.09, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 1.09, "10th_percentile": 1.09, "90th_percentile": 1.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 0.97, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 0.97, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 1.2, "10th_percentile": 1.2, "90th_percentile": 1.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 1.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.2, "10th_percentile": 1.2, "90th_percentile": 1.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 1.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1.2, "10th_percentile": 1.2, "90th_percentile": 1.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.84, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.84, "10th_percentile": 0.84, "90th_percentile": 0.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.84, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.84, "10th_percentile": 0.84, "90th_percentile": 0.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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" } ] } ] }, { "description": "FLUDROCORTISONE 0.1 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-10054", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00115-7033-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 3.26, "maximum": 7.75, "setting": "outpatient", "gross_charge": 7.75, "discounted_cash": 5.42, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 5.04, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 5.04, "10th_percentile": 5.04, "90th_percentile": 5.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 4.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 4.65, "10th_percentile": 4.65, "90th_percentile": 4.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 4.33, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 4.33, "10th_percentile": 4.33, "90th_percentile": 4.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 4.53, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.53, "10th_percentile": 4.53, "90th_percentile": 4.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 4.47, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 4.47, "10th_percentile": 4.47, "90th_percentile": 4.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 5.04, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 5.04, "10th_percentile": 5.04, "90th_percentile": 5.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3.95, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 3.95, "10th_percentile": 3.95, "90th_percentile": 3.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 4.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 4.65, "10th_percentile": 4.65, "90th_percentile": 4.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 3.76, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 3.76, "10th_percentile": 3.76, "90th_percentile": 3.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 3.76, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 3.76, "10th_percentile": 3.76, "90th_percentile": 3.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 3.64, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 3.64, "10th_percentile": 3.64, "90th_percentile": 3.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 4.53, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.53, "10th_percentile": 4.53, "90th_percentile": 4.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 4.47, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 4.47, "10th_percentile": 4.47, "90th_percentile": 4.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 3.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 3.88, "10th_percentile": 3.88, "90th_percentile": 3.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 5.18, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.18, "10th_percentile": 5.18, "90th_percentile": 5.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 6.74, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 6.74, "10th_percentile": 6.74, "90th_percentile": 6.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 4.88, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 4.88, "10th_percentile": 4.88, "90th_percentile": 4.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 5.04, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 5.04, "10th_percentile": 5.04, "90th_percentile": 5.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 6.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 6.2, "10th_percentile": 6.2, "90th_percentile": 6.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 4.21, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 4.21, "10th_percentile": 4.21, "90th_percentile": 4.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 3.77, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.77, "10th_percentile": 3.77, "90th_percentile": 3.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 3.76, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.76, "10th_percentile": 3.76, "90th_percentile": 3.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 4.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 4.65, "10th_percentile": 4.65, "90th_percentile": 4.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 4.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.65, "10th_percentile": 4.65, "90th_percentile": 4.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 4.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 4.65, "10th_percentile": 4.65, "90th_percentile": 4.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 3.26, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 3.26, "10th_percentile": 3.26, "90th_percentile": 3.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 3.26, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 3.26, "10th_percentile": 3.26, "90th_percentile": 3.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "FLUOCINONIDE 0.05 % TOP CREA", "drug_information": { "unit": 15.0, "type": "GR" }, "code_information": [ { "code": "RX-3187", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "51862-0494-15", "type": "NDC" } ], "standard_charges": [ { "minimum": 94.19, "maximum": 224.25, "setting": "outpatient", "gross_charge": 224.25, "discounted_cash": 156.97, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 94.19, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 94.19, "10th_percentile": 94.19, "90th_percentile": 94.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 94.19, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 94.19, "10th_percentile": 94.19, "90th_percentile": 94.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 105.4, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 105.4, "10th_percentile": 105.4, "90th_percentile": 105.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 131.05, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 131.05, "10th_percentile": 131.05, "90th_percentile": 131.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 129.35, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 129.35, "10th_percentile": 129.35, "90th_percentile": 129.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 112.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 112.13, "10th_percentile": 112.13, "90th_percentile": 112.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 134.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.55, "10th_percentile": 134.55, "90th_percentile": 134.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 150.02, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 150.02, "10th_percentile": 150.02, "90th_percentile": 150.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 195.1, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% 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 Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 141.28, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 141.28, "10th_percentile": 141.28, "90th_percentile": 141.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 134.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 134.55, "10th_percentile": 134.55, "90th_percentile": 134.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 145.76, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 145.76, "10th_percentile": 145.76, "90th_percentile": 145.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 134.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 134.55, "10th_percentile": 134.55, "90th_percentile": 134.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 179.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 179.4, "10th_percentile": 179.4, "90th_percentile": 179.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 121.88, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 121.88, "10th_percentile": 121.88, "90th_percentile": 121.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 108.99, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 108.99, "10th_percentile": 108.99, "90th_percentile": 108.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 108.76, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 108.76, "10th_percentile": 108.76, "90th_percentile": 108.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 134.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 134.55, "10th_percentile": 134.55, "90th_percentile": 134.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 145.76, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 145.76, "10th_percentile": 145.76, "90th_percentile": 145.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 145.76, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 145.76, "10th_percentile": 145.76, "90th_percentile": 145.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 134.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 134.55, "10th_percentile": 134.55, "90th_percentile": 134.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 131.05, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 131.05, "10th_percentile": 131.05, "90th_percentile": 131.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 129.35, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 129.35, "10th_percentile": 129.35, "90th_percentile": 129.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 114.28, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 114.28, "10th_percentile": 114.28, "90th_percentile": 114.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 125.36, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 125.36, "10th_percentile": 125.36, "90th_percentile": 125.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 108.83, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 108.83, "10th_percentile": 108.83, "90th_percentile": 108.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 108.83, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 108.83, "10th_percentile": 108.83, "90th_percentile": 108.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 224.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 224.25, "10th_percentile": 224.25, "90th_percentile": 224.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 224.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 224.25, "10th_percentile": 224.25, "90th_percentile": 224.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 224.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 224.25, "10th_percentile": 224.25, "90th_percentile": 224.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 224.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 224.25, "10th_percentile": 224.25, "90th_percentile": 224.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 224.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 224.25, "10th_percentile": 224.25, "90th_percentile": 224.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 224.25, "10th_percentile": 224.25, "90th_percentile": 224.25, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 224.25, "10th_percentile": 224.25, "90th_percentile": 224.25, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 224.25, "10th_percentile": 224.25, "90th_percentile": 224.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "FLUTICASONE FUROATE-VILANTEROL 200-25 MCG/DOSE INH DSDV", "drug_information": { "unit": 28.0, "type": "UN" }, "code_information": [ { "code": "RX-204762", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00173-0882-14", "type": "NDC" } ], "standard_charges": [ { "minimum": 570.36, "maximum": 1358.0, "setting": "outpatient", "gross_charge": 1358.0, "discounted_cash": 950.6, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 638.26, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 638.26, "10th_percentile": 638.26, "90th_percentile": 638.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 570.36, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 570.36, "10th_percentile": 570.36, "90th_percentile": 570.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 793.62, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 793.62, "10th_percentile": 793.62, "90th_percentile": 793.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 783.29, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 783.29, "10th_percentile": 783.29, "90th_percentile": 783.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 679.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 679.0, "10th_percentile": 679.0, "90th_percentile": 679.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 814.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 814.8, "10th_percentile": 814.8, "90th_percentile": 814.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 908.5, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 908.5, "10th_percentile": 908.5, "90th_percentile": 908.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 1181.46, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 1181.46, "10th_percentile": 1181.46, "90th_percentile": 1181.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 855.54, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 855.54, "10th_percentile": 855.54, "90th_percentile": 855.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 814.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 814.8, "10th_percentile": 814.8, "90th_percentile": 814.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 882.7, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 882.7, "10th_percentile": 882.7, "90th_percentile": 882.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 814.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 570.36, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 570.36, "10th_percentile": 570.36, "90th_percentile": 570.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 1086.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 1086.4, "10th_percentile": 1086.4, "90th_percentile": 1086.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 738.07, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 738.07, "10th_percentile": 738.07, "90th_percentile": 738.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 659.99, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 659.99, "10th_percentile": 659.99, "90th_percentile": 659.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 658.63, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 658.63, "10th_percentile": 658.63, "90th_percentile": 658.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 659.04, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 659.04, "10th_percentile": 659.04, "90th_percentile": 659.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 659.04, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 659.04, "10th_percentile": 659.04, "90th_percentile": 659.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 692.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 692.04, "10th_percentile": 692.04, "90th_percentile": 692.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 793.62, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 793.62, "10th_percentile": 793.62, "90th_percentile": 793.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 759.12, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 759.12, "10th_percentile": 759.12, "90th_percentile": 759.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 783.29, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 783.29, "10th_percentile": 783.29, "90th_percentile": 783.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 814.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 814.8, "10th_percentile": 814.8, "90th_percentile": 814.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 882.7, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 882.7, "10th_percentile": 882.7, "90th_percentile": 882.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 882.7, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 814.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1358.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1358.0, "10th_percentile": 1358.0, "90th_percentile": 1358.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1358.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1358.0, "10th_percentile": 1358.0, "90th_percentile": 1358.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1358.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1358.0, "10th_percentile": 1358.0, "90th_percentile": 1358.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1358.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1358.0, "10th_percentile": 1358.0, "90th_percentile": 1358.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1358.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1358.0, "10th_percentile": 1358.0, "90th_percentile": 1358.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1358.0, "10th_percentile": 1358.0, "90th_percentile": 1358.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1358.0, "10th_percentile": 1358.0, "90th_percentile": 1358.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1358.0, "10th_percentile": 1358.0, "90th_percentile": 1358.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "FLUVOXAMINE 100 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-10084", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "51079-0993-20", "type": "NDC" } ], "standard_charges": [ { "minimum": 2.94, "maximum": 7.0, "setting": "outpatient", "gross_charge": 7.0, "discounted_cash": 4.9, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 4.55, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 4.55, "10th_percentile": 4.55, "90th_percentile": 4.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 4.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3.91, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 3.91, "10th_percentile": 3.91, "90th_percentile": 3.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 4.09, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.09, "10th_percentile": 4.09, "90th_percentile": 4.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 4.04, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 4.04, "10th_percentile": 4.04, "90th_percentile": 4.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 4.55, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 4.55, "10th_percentile": 4.55, "90th_percentile": 4.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3.57, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 3.57, "10th_percentile": 3.57, "90th_percentile": 3.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 4.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 3.4, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 3.4, "10th_percentile": 3.4, "90th_percentile": 3.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 3.4, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 3.4, "10th_percentile": 3.4, "90th_percentile": 3.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 3.29, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 3.29, "10th_percentile": 3.29, "90th_percentile": 3.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 4.09, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.09, "10th_percentile": 4.09, "90th_percentile": 4.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 4.04, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 4.04, "10th_percentile": 4.04, "90th_percentile": 4.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 3.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 3.5, "10th_percentile": 3.5, "90th_percentile": 3.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 4.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.68, "10th_percentile": 4.68, "90th_percentile": 4.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 6.09, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 6.09, "10th_percentile": 6.09, "90th_percentile": 6.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 4.41, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 4.41, "10th_percentile": 4.41, "90th_percentile": 4.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 4.55, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 4.55, "10th_percentile": 4.55, "90th_percentile": 4.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 5.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 5.6, "10th_percentile": 5.6, "90th_percentile": 5.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 3.8, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 3.8, "10th_percentile": 3.8, "90th_percentile": 3.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 3.4, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.4, "10th_percentile": 3.4, "90th_percentile": 3.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 3.4, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.4, "10th_percentile": 3.4, "90th_percentile": 3.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 4.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 4.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 4.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2.94, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2.94, "10th_percentile": 2.94, "90th_percentile": 2.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2.94, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2.94, "10th_percentile": 2.94, "90th_percentile": 2.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "FOLIC ACID-VIT B6-VIT B12 2.5-25-2 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-97127", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "51991-0384-90", "type": "NDC" } ], "standard_charges": [ { "minimum": 3.26, "maximum": 7.75, "setting": "outpatient", "gross_charge": 7.75, "discounted_cash": 5.42, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 5.04, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 5.04, "10th_percentile": 5.04, "90th_percentile": 5.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 4.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 4.65, "10th_percentile": 4.65, "90th_percentile": 4.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 4.33, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 4.33, "10th_percentile": 4.33, "90th_percentile": 4.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 4.53, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.53, "10th_percentile": 4.53, "90th_percentile": 4.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 4.47, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 4.47, "10th_percentile": 4.47, "90th_percentile": 4.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 5.04, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 5.04, "10th_percentile": 5.04, "90th_percentile": 5.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3.95, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 3.95, "10th_percentile": 3.95, "90th_percentile": 3.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 4.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 4.65, "10th_percentile": 4.65, "90th_percentile": 4.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 3.76, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 3.76, "10th_percentile": 3.76, "90th_percentile": 3.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 3.76, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 3.76, "10th_percentile": 3.76, "90th_percentile": 3.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 3.64, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 3.64, "10th_percentile": 3.64, "90th_percentile": 3.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 4.53, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.53, "10th_percentile": 4.53, "90th_percentile": 4.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 4.47, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 4.47, "10th_percentile": 4.47, "90th_percentile": 4.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 3.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 3.88, "10th_percentile": 3.88, "90th_percentile": 3.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 5.18, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.18, "10th_percentile": 5.18, "90th_percentile": 5.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 6.74, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 6.74, "10th_percentile": 6.74, "90th_percentile": 6.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 4.88, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 4.88, "10th_percentile": 4.88, "90th_percentile": 4.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 5.04, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 5.04, "10th_percentile": 5.04, "90th_percentile": 5.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 6.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 6.2, "10th_percentile": 6.2, "90th_percentile": 6.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 4.21, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 4.21, "10th_percentile": 4.21, "90th_percentile": 4.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 3.77, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.77, "10th_percentile": 3.77, "90th_percentile": 3.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 3.76, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.76, "10th_percentile": 3.76, "90th_percentile": 3.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 4.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 4.65, "10th_percentile": 4.65, "90th_percentile": 4.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 4.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.65, "10th_percentile": 4.65, "90th_percentile": 4.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 4.65, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 4.65, "10th_percentile": 4.65, "90th_percentile": 4.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 3.26, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 3.26, "10th_percentile": 3.26, "90th_percentile": 3.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 3.26, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 3.26, "10th_percentile": 3.26, "90th_percentile": 3.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "FONDAPARINUX 10 MG/0.8 ML SUBQ SYRG", "drug_information": { "unit": 0.8, "type": "ML" }, "code_information": [ { "code": "RX-98215", "type": "CDM" }, { "code": "J1652", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00781-3476-95", "type": "NDC" } ], "standard_charges": [ { "minimum": 118.65, "maximum": 282.5, "setting": "outpatient", "gross_charge": 282.5, "discounted_cash": 197.75, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $282.50 @ 12.5% = $35.31 due to $0.00 Claim Price", "median_amount": 35.31, "10th_percentile": 35.31, "90th_percentile": 35.31, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $282.50 @ 12.5% = $35.31 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $282.50 @ 12.5% = $35.31 due to $0.00 Claim Price", "median_amount": 35.31, "10th_percentile": 35.31, "90th_percentile": 35.31, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $282.50 @ 12.5% = $35.31 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $282.50 @ 12.5% = $35.31 due to $0.00 Claim Price", "median_amount": 35.31, "10th_percentile": 35.31, "90th_percentile": 35.31, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $282.50 @ 12.5% = $35.31 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 282.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 282.5, "10th_percentile": 282.5, "90th_percentile": 282.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 282.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 282.5, "10th_percentile": 282.5, "90th_percentile": 282.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 282.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 282.5, "10th_percentile": 282.5, "90th_percentile": 282.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 282.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 282.5, "10th_percentile": 282.5, "90th_percentile": 282.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 282.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 282.5, "10th_percentile": 282.5, "90th_percentile": 282.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 158.77, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 158.77, "10th_percentile": 158.77, "90th_percentile": 158.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 132.78, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 132.78, "10th_percentile": 132.78, "90th_percentile": 132.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 165.09, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 165.09, "10th_percentile": 165.09, "90th_percentile": 165.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 173.46, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 173.46, "10th_percentile": 173.46, "90th_percentile": 173.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 141.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 141.25, "10th_percentile": 141.25, "90th_percentile": 141.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 169.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 169.5, "10th_percentile": 169.5, "90th_percentile": 169.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH AETNA", "standard_charge_dollar": 158.77, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 158.77, "10th_percentile": 158.77, "90th_percentile": 158.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 188.99, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 188.99, "10th_percentile": 188.99, "90th_percentile": 188.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 245.78, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 245.78, "10th_percentile": 245.78, "90th_percentile": 245.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 177.98, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 177.98, "10th_percentile": 177.98, "90th_percentile": 177.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 169.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 169.5, "10th_percentile": 169.5, "90th_percentile": 169.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 183.63, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 183.63, "10th_percentile": 183.63, "90th_percentile": 183.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 169.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 169.5, "10th_percentile": 169.5, "90th_percentile": 169.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 226.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 226.0, "10th_percentile": 226.0, "90th_percentile": 226.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 153.54, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 153.54, "10th_percentile": 153.54, "90th_percentile": 153.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 137.3, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 137.3, "10th_percentile": 137.3, "90th_percentile": 137.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 137.01, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 137.01, "10th_percentile": 137.01, "90th_percentile": 137.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 118.65, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 118.65, "10th_percentile": 118.65, "90th_percentile": 118.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 118.65, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 118.65, "10th_percentile": 118.65, "90th_percentile": 118.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 153.96, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 153.96, "10th_percentile": 153.96, "90th_percentile": 153.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 153.96, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 153.96, "10th_percentile": 153.96, "90th_percentile": 153.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 153.96, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 153.96, "10th_percentile": 153.96, "90th_percentile": 153.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 157.92, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 157.92, "10th_percentile": 157.92, "90th_percentile": 157.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 165.09, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 165.09, "10th_percentile": 165.09, "90th_percentile": 165.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 183.63, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 183.63, "10th_percentile": 183.63, "90th_percentile": 183.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 169.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 169.5, "10th_percentile": 169.5, "90th_percentile": 169.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 173.46, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 173.46, "10th_percentile": 173.46, "90th_percentile": 173.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 169.5, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 169.5, "10th_percentile": 169.5, "90th_percentile": 169.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 183.63, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 183.63, "10th_percentile": 183.63, "90th_percentile": 183.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" } ] } ] }, { "description": "FONDAPARINUX 10 MG/0.8 ML SUBQ SYRG", "drug_information": { "unit": 0.8, "type": "ML" }, "code_information": [ { "code": "RX-98215", "type": "CDM" }, { "code": "J1652", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "55111-0681-02", "type": "NDC" } ], "standard_charges": [ { "minimum": 150.99, "maximum": 359.5, "setting": "outpatient", "gross_charge": 359.5, "discounted_cash": 251.65, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $359.50 @ 12.5% = $44.94 due to $0.00 Claim Price", "median_amount": 44.94, "10th_percentile": 44.94, "90th_percentile": 44.94, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $359.50 @ 12.5% = $44.94 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $359.50 @ 12.5% = $44.94 due to $0.00 Claim Price", "median_amount": 44.94, "10th_percentile": 44.94, "90th_percentile": 44.94, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $359.50 @ 12.5% = $44.94 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $359.50 @ 12.5% = $44.94 due to $0.00 Claim Price", "median_amount": 44.94, "10th_percentile": 44.94, "90th_percentile": 44.94, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $359.50 @ 12.5% = $44.94 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 359.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 359.5, "10th_percentile": 359.5, "90th_percentile": 359.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 359.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 359.5, "10th_percentile": 359.5, "90th_percentile": 359.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 359.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 359.5, "10th_percentile": 359.5, "90th_percentile": 359.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 359.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 359.5, "10th_percentile": 359.5, "90th_percentile": 359.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 359.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 359.5, "10th_percentile": 359.5, "90th_percentile": 359.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 202.04, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 202.04, "10th_percentile": 202.04, "90th_percentile": 202.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 168.97, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 168.97, "10th_percentile": 168.97, "90th_percentile": 168.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 210.09, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 210.09, "10th_percentile": 210.09, "90th_percentile": 210.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 220.73, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 220.73, "10th_percentile": 220.73, "90th_percentile": 220.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 179.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 179.75, "10th_percentile": 179.75, "90th_percentile": 179.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 215.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 215.7, "10th_percentile": 215.7, "90th_percentile": 215.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH AETNA", "standard_charge_dollar": 202.04, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 202.04, "10th_percentile": 202.04, "90th_percentile": 202.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 240.51, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 240.51, "10th_percentile": 240.51, "90th_percentile": 240.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 312.77, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 312.77, "10th_percentile": 312.77, "90th_percentile": 312.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 226.49, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 226.49, "10th_percentile": 226.49, "90th_percentile": 226.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 215.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 215.7, "10th_percentile": 215.7, "90th_percentile": 215.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 233.68, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 233.68, "10th_percentile": 233.68, "90th_percentile": 233.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 215.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 215.7, "10th_percentile": 215.7, "90th_percentile": 215.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 287.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 287.6, "10th_percentile": 287.6, "90th_percentile": 287.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 195.39, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 195.39, "10th_percentile": 195.39, "90th_percentile": 195.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 174.72, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 174.72, "10th_percentile": 174.72, "90th_percentile": 174.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 174.36, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 174.36, "10th_percentile": 174.36, "90th_percentile": 174.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 150.99, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 150.99, "10th_percentile": 150.99, "90th_percentile": 150.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 150.99, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 150.99, "10th_percentile": 150.99, "90th_percentile": 150.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 195.93, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 195.93, "10th_percentile": 195.93, "90th_percentile": 195.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 195.93, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 195.93, "10th_percentile": 195.93, "90th_percentile": 195.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 195.93, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 195.93, "10th_percentile": 195.93, "90th_percentile": 195.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 200.96, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 200.96, "10th_percentile": 200.96, "90th_percentile": 200.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 210.09, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 210.09, "10th_percentile": 210.09, "90th_percentile": 210.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 233.68, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 233.68, "10th_percentile": 233.68, "90th_percentile": 233.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 215.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 215.7, "10th_percentile": 215.7, "90th_percentile": 215.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 220.73, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 220.73, "10th_percentile": 220.73, "90th_percentile": 220.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 215.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 215.7, "10th_percentile": 215.7, "90th_percentile": 215.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 233.68, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 233.68, "10th_percentile": 233.68, "90th_percentile": 233.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" } ] } ] }, { "description": "FONDAPARINUX 10 MG/0.8 ML SUBQ SYRG", "drug_information": { "unit": 0.8, "type": "ML" }, "code_information": [ { "code": "RX-98215", "type": "CDM" }, { "code": "J1652", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "55111-0681-11", "type": "NDC" } ], "standard_charges": [ { "minimum": 150.99, "maximum": 359.5, "setting": "outpatient", "gross_charge": 359.5, "discounted_cash": 251.65, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $359.50 @ 12.5% = $44.94 due to $0.00 Claim Price", "median_amount": 44.94, "10th_percentile": 44.94, "90th_percentile": 44.94, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $359.50 @ 12.5% = $44.94 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $359.50 @ 12.5% = $44.94 due to $0.00 Claim Price", "median_amount": 44.94, "10th_percentile": 44.94, "90th_percentile": 44.94, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $359.50 @ 12.5% = $44.94 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $359.50 @ 12.5% = $44.94 due to $0.00 Claim Price", "median_amount": 44.94, "10th_percentile": 44.94, "90th_percentile": 44.94, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $359.50 @ 12.5% = $44.94 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 359.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 359.5, "10th_percentile": 359.5, "90th_percentile": 359.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 359.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 359.5, "10th_percentile": 359.5, "90th_percentile": 359.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 359.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 359.5, "10th_percentile": 359.5, "90th_percentile": 359.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 359.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 359.5, "10th_percentile": 359.5, "90th_percentile": 359.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 359.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 359.5, "10th_percentile": 359.5, "90th_percentile": 359.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 202.04, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 202.04, "10th_percentile": 202.04, "90th_percentile": 202.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 168.97, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 168.97, "10th_percentile": 168.97, "90th_percentile": 168.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 210.09, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 210.09, "10th_percentile": 210.09, "90th_percentile": 210.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 220.73, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 220.73, "10th_percentile": 220.73, "90th_percentile": 220.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 179.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 179.75, "10th_percentile": 179.75, "90th_percentile": 179.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 215.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 215.7, "10th_percentile": 215.7, "90th_percentile": 215.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH AETNA", "standard_charge_dollar": 202.04, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 202.04, "10th_percentile": 202.04, "90th_percentile": 202.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 240.51, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 240.51, "10th_percentile": 240.51, "90th_percentile": 240.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 312.77, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 312.77, "10th_percentile": 312.77, "90th_percentile": 312.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 226.49, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 226.49, "10th_percentile": 226.49, "90th_percentile": 226.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 215.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 215.7, "10th_percentile": 215.7, "90th_percentile": 215.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 233.68, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 233.68, "10th_percentile": 233.68, "90th_percentile": 233.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 215.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 215.7, "10th_percentile": 215.7, "90th_percentile": 215.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 287.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 287.6, "10th_percentile": 287.6, "90th_percentile": 287.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 195.39, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 195.39, "10th_percentile": 195.39, "90th_percentile": 195.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 174.72, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 174.72, "10th_percentile": 174.72, "90th_percentile": 174.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 174.36, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 174.36, "10th_percentile": 174.36, "90th_percentile": 174.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 150.99, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 150.99, "10th_percentile": 150.99, "90th_percentile": 150.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 150.99, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 150.99, "10th_percentile": 150.99, "90th_percentile": 150.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 195.93, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 195.93, "10th_percentile": 195.93, "90th_percentile": 195.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 195.93, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 195.93, "10th_percentile": 195.93, "90th_percentile": 195.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 195.93, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 195.93, "10th_percentile": 195.93, "90th_percentile": 195.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 200.96, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 200.96, "10th_percentile": 200.96, "90th_percentile": 200.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 210.09, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 210.09, "10th_percentile": 210.09, "90th_percentile": 210.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 233.68, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 233.68, "10th_percentile": 233.68, "90th_percentile": 233.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 215.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 215.7, "10th_percentile": 215.7, "90th_percentile": 215.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 220.73, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 220.73, "10th_percentile": 220.73, "90th_percentile": 220.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 215.7, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 215.7, "10th_percentile": 215.7, "90th_percentile": 215.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 233.68, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 233.68, "10th_percentile": 233.68, "90th_percentile": 233.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" } ] } ] }, { "description": "FONDAPARINUX 5 MG/0.4 ML SUBQ SYRG", "drug_information": { "unit": 0.4, "type": "ML" }, "code_information": [ { "code": "RX-39803", "type": "CDM" }, { "code": "J1652", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "55111-0679-11", "type": "NDC" } ], "standard_charges": [ { "minimum": 73.4, "maximum": 174.75, "setting": "outpatient", "gross_charge": 174.75, "discounted_cash": 122.32, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $174.75 @ 12.5% = $21.84 due to $0.00 Claim Price", "median_amount": 21.84, "10th_percentile": 21.84, "90th_percentile": 21.84, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $174.75 @ 12.5% = $21.84 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $174.75 @ 12.5% = $21.84 due to $0.00 Claim Price", "median_amount": 21.84, "10th_percentile": 21.84, "90th_percentile": 21.84, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $174.75 @ 12.5% = $21.84 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $174.75 @ 12.5% = $21.84 due to $0.00 Claim Price", "median_amount": 21.84, "10th_percentile": 21.84, "90th_percentile": 21.84, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $174.75 @ 12.5% = $21.84 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 174.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 174.75, "10th_percentile": 174.75, "90th_percentile": 174.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 174.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 174.75, "10th_percentile": 174.75, "90th_percentile": 174.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 174.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 174.75, "10th_percentile": 174.75, "90th_percentile": 174.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 174.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 174.75, "10th_percentile": 174.75, "90th_percentile": 174.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 174.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 174.75, "10th_percentile": 174.75, "90th_percentile": 174.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 98.21, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 98.21, "10th_percentile": 98.21, "90th_percentile": 98.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 82.13, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 82.13, "10th_percentile": 82.13, "90th_percentile": 82.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 102.12, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 102.12, "10th_percentile": 102.12, "90th_percentile": 102.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 107.3, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 107.3, "10th_percentile": 107.3, "90th_percentile": 107.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 87.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 87.38, "10th_percentile": 87.38, "90th_percentile": 87.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 104.85, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 104.85, "10th_percentile": 104.85, "90th_percentile": 104.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH AETNA", "standard_charge_dollar": 98.21, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 98.21, "10th_percentile": 98.21, "90th_percentile": 98.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 116.91, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 116.91, "10th_percentile": 116.91, "90th_percentile": 116.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 152.03, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 152.03, "10th_percentile": 152.03, "90th_percentile": 152.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 110.09, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 110.09, "10th_percentile": 110.09, "90th_percentile": 110.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 104.85, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 104.85, "10th_percentile": 104.85, "90th_percentile": 104.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 113.59, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 113.59, "10th_percentile": 113.59, "90th_percentile": 113.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 104.85, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 104.85, "10th_percentile": 104.85, "90th_percentile": 104.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 139.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 139.8, "10th_percentile": 139.8, "90th_percentile": 139.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 94.98, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 94.98, "10th_percentile": 94.98, "90th_percentile": 94.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 84.93, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 84.93, "10th_percentile": 84.93, "90th_percentile": 84.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 84.75, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 84.75, "10th_percentile": 84.75, "90th_percentile": 84.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 73.4, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 73.4, "10th_percentile": 73.4, "90th_percentile": 73.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 73.4, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 73.4, "10th_percentile": 73.4, "90th_percentile": 73.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 95.24, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 95.24, "10th_percentile": 95.24, "90th_percentile": 95.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 95.24, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 95.24, "10th_percentile": 95.24, "90th_percentile": 95.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 95.24, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 95.24, "10th_percentile": 95.24, "90th_percentile": 95.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 97.69, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 97.69, "10th_percentile": 97.69, "90th_percentile": 97.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 102.12, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 102.12, "10th_percentile": 102.12, "90th_percentile": 102.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 113.59, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 113.59, "10th_percentile": 113.59, "90th_percentile": 113.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 104.85, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 104.85, "10th_percentile": 104.85, "90th_percentile": 104.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 107.3, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 107.3, "10th_percentile": 107.3, "90th_percentile": 107.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 104.85, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 104.85, "10th_percentile": 104.85, "90th_percentile": 104.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 113.59, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 113.59, "10th_percentile": 113.59, "90th_percentile": 113.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" } ] } ] }, { "description": "FUROSEMIDE 10 MG ORAL HALF TAB", "drug_information": { "unit": 10.0, "type": "ME" }, "code_information": [ { "code": "RX-4080000034", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00000-0100-34", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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" } ] } ] }, { "description": "FUROSEMIDE 10 MG/ML ORAL SOLN", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "RX-3292", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00054-3294-46", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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" } ] } ] }, { "description": "FUROSEMIDE 20 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-3294", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "69315-0116-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 4.0, "10th_percentile": 4.0, "90th_percentile": 4.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4.00 @ 12.5% = $0.50 due to $0.00 Claim Price", "median_amount": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4.00 @ 12.5% = $0.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4.00 @ 12.5% = $0.50 due to $0.00 Claim Price", "median_amount": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4.00 @ 12.5% = $0.50 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4.00 @ 12.5% = $0.50 due to $0.00 Claim Price", "median_amount": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4.00 @ 12.5% = $0.50 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.18, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2.18, "10th_percentile": 2.18, "90th_percentile": 2.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2.18, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2.18, "10th_percentile": 2.18, "90th_percentile": 2.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2.18, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2.18, "10th_percentile": 2.18, "90th_percentile": 2.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.46, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 2.46, "10th_percentile": 2.46, "90th_percentile": 2.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.46, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 2.46, "10th_percentile": 2.46, "90th_percentile": 2.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "GABAPENTIN 300 MG ORAL CAP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-18308", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00904-6666-61", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "GABAPENTIN 400 MG ORAL CAP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-18307", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "50228-0181-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [ { "code": "388", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 34943.14, "maximum": 34943.14, "setting": "inpatient", "gross_charge": 61667.0, "discounted_cash": 43166.9, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_percentage": 47.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 28983.49, "10th_percentile": 28983.49, "90th_percentile": 28983.49, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_percentage": 49.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 30216.83, "10th_percentile": 30216.83, "90th_percentile": 30216.83, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Re-evaluated: HLB.776243570; Using historical claim(s); Scope: All Financial Classes; Cases: 2; Inpatient Services; 63% Billed", "median_amount": 38850.21, "10th_percentile": 38850.21, "90th_percentile": 38850.21, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Re-evaluated: HLB.776243570; Using historical claim(s); Scope: All Financial Classes; Cases: 2; Inpatient Services; 54.35% Billed", "median_amount": 33516.01, "10th_percentile": 33516.01, "90th_percentile": 33516.01, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_percentage": 44.0, "standard_charge_algorithm": "Re-evaluated: HLB.776243570; Using historical claim(s); Scope: All Financial Classes; Cases: 2; Inpatient Services; 44% Billed", "median_amount": 27133.48, "10th_percentile": 27133.48, "90th_percentile": 27133.48, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_percentage": 44.0, "standard_charge_algorithm": "Re-evaluated: HLB.776243570; Using historical claim(s); Scope: All Financial Classes; Cases: 2; Inpatient Services; 44% Billed", "median_amount": 27133.48, "10th_percentile": 27133.48, "90th_percentile": 27133.48, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.776243570; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 61667.0, "10th_percentile": 61667.0, "90th_percentile": 61667.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.776243570; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 61667.0, "10th_percentile": 61667.0, "90th_percentile": 61667.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.776243570; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 61667.0, "10th_percentile": 61667.0, "90th_percentile": 61667.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.776243570; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 61667.0, "10th_percentile": 61667.0, "90th_percentile": 61667.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.776243570; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 61667.0, "10th_percentile": 61667.0, "90th_percentile": 61667.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 34943.14, "standard_charge_algorithm": "Re-evaluated: HLB.776243570; Using historical claim(s); Scope: All Financial Classes; Cases: 2; IP Rehab; FSC: HB MRH & NWR CMG IP REHAB RATES, and; Pricing Extension - HB MRH IP REHAB PPS MEDICARE", "median_amount": 35714.97, "10th_percentile": 35714.97, "90th_percentile": 35714.97, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 34943.14, "standard_charge_algorithm": "Re-evaluated: HLB.776243570; Using historical claim(s); Scope: All Financial Classes; Cases: 2; IP Rehab; FSC: HB MRH & NWR CMG IP REHAB RATES, and; Pricing Extension - HB MRH IP REHAB PPS MEDICARE", "median_amount": 35714.97, "10th_percentile": 35714.97, "90th_percentile": 35714.97, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_dollar": 34943.14, "standard_charge_algorithm": "Re-evaluated: HLB.776243570; Using historical claim(s); Scope: All Financial Classes; Cases: 2; IP Rehab; FSC: HB MRH & NWR CMG IP REHAB RATES, and; Pricing Extension - HB MRH IP REHAB PPS MEDICARE", "median_amount": 35714.97, "10th_percentile": 35714.97, "90th_percentile": 35714.97, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_dollar": 34943.14, "standard_charge_algorithm": "Re-evaluated: HLB.776243570; Using historical claim(s); Scope: All Financial Classes; Cases: 2; IP Rehab; FSC: HB MRH & NWR CMG IP REHAB RATES, and; Pricing Extension - HB MRH IP REHAB PPS MEDICARE", "median_amount": 35714.97, "10th_percentile": 35714.97, "90th_percentile": 35714.97, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_dollar": 34943.14, "standard_charge_algorithm": "Re-evaluated: HLB.776243570; Using historical claim(s); Scope: All Financial Classes; Cases: 2; IP Rehab; FSC: HB MRH & NWR CMG IP REHAB RATES, and; Pricing Extension - HB MRH IP REHAB PPS MEDICARE", "median_amount": 35714.97, "10th_percentile": 35714.97, "90th_percentile": 35714.97, "count": "1 through 10", "methodology": "case rate" } ] } ] }, { "description": "GLIMEPIRIDE 4 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-16357", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "68084-0327-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 2.94, "maximum": 7.0, "setting": "outpatient", "gross_charge": 7.0, "discounted_cash": 4.9, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 4.55, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 4.55, "10th_percentile": 4.55, "90th_percentile": 4.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 4.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3.91, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 3.91, "10th_percentile": 3.91, "90th_percentile": 3.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 4.09, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.09, "10th_percentile": 4.09, "90th_percentile": 4.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 4.04, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 4.04, "10th_percentile": 4.04, "90th_percentile": 4.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 4.55, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 4.55, "10th_percentile": 4.55, "90th_percentile": 4.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3.57, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 3.57, "10th_percentile": 3.57, "90th_percentile": 3.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 4.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 3.4, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 3.4, "10th_percentile": 3.4, "90th_percentile": 3.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 3.4, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 3.4, "10th_percentile": 3.4, "90th_percentile": 3.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 3.29, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 3.29, "10th_percentile": 3.29, "90th_percentile": 3.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 4.09, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.09, "10th_percentile": 4.09, "90th_percentile": 4.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 4.04, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 4.04, "10th_percentile": 4.04, "90th_percentile": 4.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 3.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 3.5, "10th_percentile": 3.5, "90th_percentile": 3.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 4.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.68, "10th_percentile": 4.68, "90th_percentile": 4.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 6.09, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 6.09, "10th_percentile": 6.09, "90th_percentile": 6.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 4.41, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 4.41, "10th_percentile": 4.41, "90th_percentile": 4.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 4.55, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 4.55, "10th_percentile": 4.55, "90th_percentile": 4.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 5.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 5.6, "10th_percentile": 5.6, "90th_percentile": 5.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 3.8, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 3.8, "10th_percentile": 3.8, "90th_percentile": 3.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 3.4, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.4, "10th_percentile": 3.4, "90th_percentile": 3.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 3.4, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.4, "10th_percentile": 3.4, "90th_percentile": 3.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 4.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 4.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 4.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2.94, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2.94, "10th_percentile": 2.94, "90th_percentile": 2.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2.94, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2.94, "10th_percentile": 2.94, "90th_percentile": 2.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "GLIPIZIDE 10 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-10116", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "60505-0142-00", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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" } ] } ] }, { "description": "GLYCERIN (ADULT) RECT SUPP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-15053", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "46122-0221-71", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.42, "maximum": 1.0, "setting": "outpatient", "gross_charge": 1.0, "discounted_cash": 0.7, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 0.56, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 0.56, "10th_percentile": 0.56, "90th_percentile": 0.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 0.51, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 0.51, "10th_percentile": 0.51, "90th_percentile": 0.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 0.54, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 0.8, "10th_percentile": 0.8, "90th_percentile": 0.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 0.63, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 0.87, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 0.87, "10th_percentile": 0.87, "90th_percentile": 0.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 0.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.47, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 0.47, "10th_percentile": 0.47, "90th_percentile": 0.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 0.67, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.67, "10th_percentile": 0.67, "90th_percentile": 0.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 0.49, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.49, "10th_percentile": 0.49, "90th_percentile": 0.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS HMO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 0.58, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 0.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 0.6, "10th_percentile": 0.6, "90th_percentile": 0.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 0.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "GLYCERIN 99.5 % TOP SOLN", "drug_information": { "unit": 177.0, "type": "ML" }, "code_information": [ { "code": "RX-39622", "type": "CDM" }, { "code": "27100000", "type": "LOCAL" }, { "code": "0271", "type": "RC" }, { "code": "00395-1031-96", "type": "NDC" } ], "standard_charges": [ { "minimum": 16.49, "maximum": 39.25, "setting": "outpatient", "gross_charge": 39.25, "discounted_cash": 27.47, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 39.25, "10th_percentile": 39.25, "90th_percentile": 39.25, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 39.25, "10th_percentile": 39.25, "90th_percentile": 39.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 39.25, "10th_percentile": 39.25, "90th_percentile": 39.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 39.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 39.25, "10th_percentile": 39.25, "90th_percentile": 39.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 39.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 39.25, "10th_percentile": 39.25, "90th_percentile": 39.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 39.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 39.25, "10th_percentile": 39.25, "90th_percentile": 39.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 39.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 39.25, "10th_percentile": 39.25, "90th_percentile": 39.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 39.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 39.25, "10th_percentile": 39.25, "90th_percentile": 39.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 18.45, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 18.45, "10th_percentile": 18.45, "90th_percentile": 18.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 16.49, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 22.94, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 22.94, "10th_percentile": 22.94, "90th_percentile": 22.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 22.64, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 22.64, "10th_percentile": 22.64, "90th_percentile": 22.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 19.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 19.63, "10th_percentile": 19.63, "90th_percentile": 19.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 23.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.55, "10th_percentile": 23.55, "90th_percentile": 23.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH FIRST HEALTH", "standard_charge_dollar": 26.26, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.26, "10th_percentile": 26.26, "90th_percentile": 26.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 34.15, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 34.15, "10th_percentile": 34.15, "90th_percentile": 34.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 24.73, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 24.73, "10th_percentile": 24.73, "90th_percentile": 24.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 23.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 23.55, "10th_percentile": 23.55, "90th_percentile": 23.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 25.51, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 25.51, "10th_percentile": 25.51, "90th_percentile": 25.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 23.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 23.55, "10th_percentile": 23.55, "90th_percentile": 23.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 16.49, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 31.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 31.4, "10th_percentile": 31.4, "90th_percentile": 31.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 21.33, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 21.33, "10th_percentile": 21.33, "90th_percentile": 21.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 19.08, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 19.08, "10th_percentile": 19.08, "90th_percentile": 19.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 19.04, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 19.04, "10th_percentile": 19.04, "90th_percentile": 19.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 20.0, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 20.0, "10th_percentile": 20.0, "90th_percentile": 20.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 19.05, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 19.05, "10th_percentile": 19.05, "90th_percentile": 19.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 19.05, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 19.05, "10th_percentile": 19.05, "90th_percentile": 19.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 22.94, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 22.94, "10th_percentile": 22.94, "90th_percentile": 22.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 21.94, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 21.94, "10th_percentile": 21.94, "90th_percentile": 21.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 22.64, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 22.64, "10th_percentile": 22.64, "90th_percentile": 22.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 23.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 23.55, "10th_percentile": 23.55, "90th_percentile": 23.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 25.51, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 25.51, "10th_percentile": 25.51, "90th_percentile": 25.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 25.51, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 25.51, "10th_percentile": 25.51, "90th_percentile": 25.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 23.55, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 23.55, "10th_percentile": 23.55, "90th_percentile": 23.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" } ] } ] }, { "description": "HALOPERIDOL 1 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-3579", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "51079-0734-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.68, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH 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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH 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": "GLOBAL EXCEL [1712]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.94, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "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; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2.31, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 2.31, "10th_percentile": 2.31, "90th_percentile": 2.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.34, "10th_percentile": 2.34, "90th_percentile": 2.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1.88, "10th_percentile": 1.88, "90th_percentile": 1.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 2.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.04, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2.24, "10th_percentile": 2.24, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2.52, "10th_percentile": 2.52, "90th_percentile": 2.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2.17, "10th_percentile": 2.17, "90th_percentile": 2.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" } ] } ] }, { "description": "HB 9vhpv Vacc 2/3 Dose Sched Im Use", "code_information": [ { "code": "PX-63600155", "type": "CDM" }, { "code": "90651", "type": "CPT" }, { "code": "0636", "type": "RC" } ], "standard_charges": [ { "minimum": 254.1, "maximum": 605.0, "setting": "outpatient", "gross_charge": 605.0, "discounted_cash": 423.5, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $605.00 @ 12.5% = $75.63 due to $0.00 Claim Price", "median_amount": 75.63, "10th_percentile": 75.63, "90th_percentile": 75.63, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $605.00 @ 12.5% = $75.63 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $605.00 @ 12.5% = $75.63 due to $0.00 Claim Price", "median_amount": 75.63, "10th_percentile": 75.63, "90th_percentile": 75.63, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $605.00 @ 12.5% = $75.63 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $605.00 @ 12.5% = $75.63 due to $0.00 Claim Price", "median_amount": 75.63, "10th_percentile": 75.63, "90th_percentile": 75.63, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $605.00 @ 12.5% = $75.63 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 393.25, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 393.25, "10th_percentile": 393.25, "90th_percentile": 393.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 363.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 363.0, "10th_percentile": 363.0, "90th_percentile": 363.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 393.25, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 393.25, "10th_percentile": 393.25, "90th_percentile": 393.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 371.47, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 371.47, "10th_percentile": 371.47, "90th_percentile": 371.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 363.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 363.0, "10th_percentile": 363.0, "90th_percentile": 363.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 338.2, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 338.2, "10th_percentile": 338.2, "90th_percentile": 338.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 353.56, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 353.56, "10th_percentile": 353.56, "90th_percentile": 353.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 329.73, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 329.73, "10th_percentile": 329.73, "90th_percentile": 329.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 329.73, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 329.73, "10th_percentile": 329.73, "90th_percentile": 329.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 329.73, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 329.73, "10th_percentile": 329.73, "90th_percentile": 329.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 254.1, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 254.1, "10th_percentile": 254.1, "90th_percentile": 254.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 254.1, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 254.1, "10th_percentile": 254.1, "90th_percentile": 254.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 293.43, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 293.43, "10th_percentile": 293.43, "90th_percentile": 293.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 294.03, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 294.03, "10th_percentile": 294.03, "90th_percentile": 294.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_dollar": 340.01, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 340.01, "10th_percentile": 340.01, "90th_percentile": 340.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH AETNA", "standard_charge_dollar": 340.01, "standard_charge_percentage": 56.2, "standard_charge_algorithm": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883", "median_amount": 340.01, "10th_percentile": 340.01, "90th_percentile": 340.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs OP; 56.2% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $883" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 393.25, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 393.25, "10th_percentile": 393.25, "90th_percentile": 393.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 371.47, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 371.47, "10th_percentile": 371.47, "90th_percentile": 371.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 302.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 302.5, "10th_percentile": 302.5, "90th_percentile": 302.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 404.75, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 404.75, "10th_percentile": 404.75, "90th_percentile": 404.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 526.35, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 526.35, "10th_percentile": 526.35, "90th_percentile": 526.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 484.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 484.0, "10th_percentile": 484.0, "90th_percentile": 484.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 353.56, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 353.56, "10th_percentile": 353.56, "90th_percentile": 353.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 381.15, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 381.15, "10th_percentile": 381.15, "90th_percentile": 381.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 284.35, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 284.35, "10th_percentile": 284.35, "90th_percentile": 284.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 328.82, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 328.82, "10th_percentile": 328.82, "90th_percentile": 328.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 363.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 363.0, "10th_percentile": 363.0, "90th_percentile": 363.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 363.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 363.0, "10th_percentile": 363.0, "90th_percentile": 363.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 363.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 363.0, "10th_percentile": 363.0, "90th_percentile": 363.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 605.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 605.0, "10th_percentile": 605.0, "90th_percentile": 605.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 605.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 605.0, "10th_percentile": 605.0, "90th_percentile": 605.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 605.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 605.0, "10th_percentile": 605.0, "90th_percentile": 605.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 605.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 605.0, "10th_percentile": 605.0, "90th_percentile": 605.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 605.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 605.0, "10th_percentile": 605.0, "90th_percentile": 605.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Ablate Arrhythmia Add On", "code_information": [ { "code": "PX-48100102", "type": "CDM" }, { "code": "93655", "type": "CPT" }, { "code": "0481", "type": "RC" } ], "standard_charges": [ { "minimum": 15151.74, "maximum": 16888.4, "setting": "outpatient", "gross_charge": 25169.0, "discounted_cash": 17618.3, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 15151.74, "standard_charge_percentage": 60.2, "standard_charge_algorithm": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15151.74, "10th_percentile": 15151.74, "90th_percentile": 15151.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 16888.4, "standard_charge_percentage": 67.1, "standard_charge_algorithm": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 16888.4, "10th_percentile": 16888.4, "90th_percentile": 16888.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "HB Access Thoracic Lymph Duct", "code_information": [ { "code": "PX-36100533", "type": "CDM" }, { "code": "38794", "type": "CPT" }, { "code": "0761", "type": "RC" } ], "standard_charges": [ { "minimum": 207.9, "maximum": 495.0, "setting": "outpatient", "gross_charge": 495.0, "discounted_cash": 346.5, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $495.00 @ 12.5% = $61.88 due to $0.00 Claim Price", "median_amount": 61.88, "10th_percentile": 61.88, "90th_percentile": 61.88, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $495.00 @ 12.5% = $61.88 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $495.00 @ 12.5% = $61.88 due to $0.00 Claim Price", "median_amount": 61.88, "10th_percentile": 61.88, "90th_percentile": 61.88, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $495.00 @ 12.5% = $61.88 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $495.00 @ 12.5% = $61.88 due to $0.00 Claim Price", "median_amount": 61.88, "10th_percentile": 61.88, "90th_percentile": 61.88, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $495.00 @ 12.5% = $61.88 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 321.75, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 321.75, "10th_percentile": 321.75, "90th_percentile": 321.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 297.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 297.0, "10th_percentile": 297.0, "90th_percentile": 297.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 303.93, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 303.93, "10th_percentile": 303.93, "90th_percentile": 303.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 297.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 297.0, "10th_percentile": 297.0, "90th_percentile": 297.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 276.71, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 276.71, "10th_percentile": 276.71, "90th_percentile": 276.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 289.28, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 289.28, "10th_percentile": 289.28, "90th_percentile": 289.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 269.78, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 269.78, "10th_percentile": 269.78, "90th_percentile": 269.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 269.78, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 269.78, "10th_percentile": 269.78, "90th_percentile": 269.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 269.78, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 269.78, "10th_percentile": 269.78, "90th_percentile": 269.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 207.9, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 207.9, "10th_percentile": 207.9, "90th_percentile": 207.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 207.9, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 207.9, "10th_percentile": 207.9, "90th_percentile": 207.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 303.93, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 303.93, "10th_percentile": 303.93, "90th_percentile": 303.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 396.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 396.0, "10th_percentile": 396.0, "90th_percentile": 396.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 331.16, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 331.16, "10th_percentile": 331.16, "90th_percentile": 331.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 430.65, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 430.65, "10th_percentile": 430.65, "90th_percentile": 430.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 289.28, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 289.28, "10th_percentile": 289.28, "90th_percentile": 289.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH THE ALLIANCE", "standard_charge_dollar": 269.03, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 269.03, "10th_percentile": 269.03, "90th_percentile": 269.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 311.85, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 311.85, "10th_percentile": 311.85, "90th_percentile": 311.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 232.65, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 232.65, "10th_percentile": 232.65, "90th_percentile": 232.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 247.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 247.5, "10th_percentile": 247.5, "90th_percentile": 247.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 297.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 297.0, "10th_percentile": 297.0, "90th_percentile": 297.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 297.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 297.0, "10th_percentile": 297.0, "90th_percentile": 297.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 297.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 297.0, "10th_percentile": 297.0, "90th_percentile": 297.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 495.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 495.0, "10th_percentile": 495.0, "90th_percentile": 495.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 495.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 495.0, "10th_percentile": 495.0, "90th_percentile": 495.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 495.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 495.0, "10th_percentile": 495.0, "90th_percentile": 495.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 495.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 495.0, "10th_percentile": 495.0, "90th_percentile": 495.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 495.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 495.0, "10th_percentile": 495.0, "90th_percentile": 495.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Adrenocordicotropic Hormone", "code_information": [ { "code": "PX-30105020", "type": "CDM" }, { "code": "82024", "type": "CPT" }, { "code": "0301", "type": "RC" } ], "standard_charges": [ { "minimum": 98.7, "maximum": 235.0, "setting": "outpatient", "gross_charge": 235.0, "discounted_cash": 164.5, "payers_information": [ { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_algorithm": "No contract line matched", "median_amount": 235.0, "10th_percentile": 235.0, "90th_percentile": 235.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_algorithm": "No contract line matched", "median_amount": 235.0, "10th_percentile": 235.0, "90th_percentile": 235.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_algorithm": "No contract line matched", "median_amount": 235.0, "10th_percentile": 235.0, "90th_percentile": 235.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_algorithm": "No contract line matched", "median_amount": 235.0, "10th_percentile": 235.0, "90th_percentile": 235.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 235.0, "10th_percentile": 235.0, "90th_percentile": 235.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 235.0, "10th_percentile": 235.0, "90th_percentile": 235.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_algorithm": "No contract line matched", "median_amount": 235.0, "10th_percentile": 235.0, "90th_percentile": 235.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 235.0, "10th_percentile": 235.0, "90th_percentile": 235.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 235.0, "10th_percentile": 235.0, "90th_percentile": 235.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 235.0, "10th_percentile": 235.0, "90th_percentile": 235.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $235.00 @ 12.5% = $29.38 due to $0.00 Claim Price", "median_amount": 29.38, "10th_percentile": 29.38, "90th_percentile": 29.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $235.00 @ 12.5% = $29.38 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $235.00 @ 12.5% = $29.38 due to $0.00 Claim Price", "median_amount": 29.38, "10th_percentile": 29.38, "90th_percentile": 29.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $235.00 @ 12.5% = $29.38 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $235.00 @ 12.5% = $29.38 due to $0.00 Claim Price", "median_amount": 29.38, "10th_percentile": 29.38, "90th_percentile": 29.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $235.00 @ 12.5% = $29.38 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 98.7, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 98.7, "10th_percentile": 98.7, "90th_percentile": 98.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 98.7, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 98.7, "10th_percentile": 98.7, "90th_percentile": 98.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 141.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 141.0, "10th_percentile": 141.0, "90th_percentile": 141.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 110.45, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 110.45, "10th_percentile": 110.45, "90th_percentile": 110.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 148.05, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 148.05, "10th_percentile": 148.05, "90th_percentile": 148.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 127.72, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 127.72, "10th_percentile": 127.72, "90th_percentile": 127.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 117.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 117.5, "10th_percentile": 117.5, "90th_percentile": 117.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 137.33, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 137.33, "10th_percentile": 137.33, "90th_percentile": 137.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 144.29, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 144.29, "10th_percentile": 144.29, "90th_percentile": 144.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 144.29, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 144.29, "10th_percentile": 144.29, "90th_percentile": 144.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 137.33, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 137.33, "10th_percentile": 137.33, "90th_percentile": 137.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 131.37, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 131.37, "10th_percentile": 131.37, "90th_percentile": 131.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 128.08, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 128.08, "10th_percentile": 128.08, "90th_percentile": 128.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 128.08, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 128.08, "10th_percentile": 128.08, "90th_percentile": 128.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 128.08, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 128.08, "10th_percentile": 128.08, "90th_percentile": 128.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 235.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 235.0, "10th_percentile": 235.0, "90th_percentile": 235.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 235.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 235.0, "10th_percentile": 235.0, "90th_percentile": 235.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 235.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 235.0, "10th_percentile": 235.0, "90th_percentile": 235.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 235.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 235.0, "10th_percentile": 235.0, "90th_percentile": 235.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 235.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 235.0, "10th_percentile": 235.0, "90th_percentile": 235.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Albumin Level", "code_information": [ { "code": "PX-30105029", "type": "CDM" }, { "code": "82040", "type": "CPT" }, { "code": "0301", "type": "RC" } ], "standard_charges": [ { "minimum": 23.52, "maximum": 56.0, "setting": "outpatient", "gross_charge": 56.0, "discounted_cash": 39.2, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_algorithm": "No contract line matched", "median_amount": 56.0, "10th_percentile": 56.0, "90th_percentile": 56.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $56.00 @ 12.5% = $7.00 due to $0.00 Claim Price", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $56.00 @ 12.5% = $7.00 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $56.00 @ 12.5% = $7.00 due to $0.00 Claim Price", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $56.00 @ 12.5% = $7.00 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $56.00 @ 12.5% = $7.00 due to $0.00 Claim Price", "median_amount": 7.0, "10th_percentile": 7.0, "90th_percentile": 7.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $56.00 @ 12.5% = $7.00 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 23.52, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 23.52, "10th_percentile": 23.52, "90th_percentile": 23.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 23.52, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 23.52, "10th_percentile": 23.52, "90th_percentile": 23.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 33.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 33.6, "10th_percentile": 33.6, "90th_percentile": 33.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 33.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 33.6, "10th_percentile": 33.6, "90th_percentile": 33.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 33.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 33.6, "10th_percentile": 33.6, "90th_percentile": 33.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 26.32, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 26.32, "10th_percentile": 26.32, "90th_percentile": 26.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 35.28, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 35.28, "10th_percentile": 35.28, "90th_percentile": 35.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 30.44, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 30.44, "10th_percentile": 30.44, "90th_percentile": 30.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 28.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 28.0, "10th_percentile": 28.0, "90th_percentile": 28.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 32.73, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 32.73, "10th_percentile": 32.73, "90th_percentile": 32.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 34.38, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 34.38, "10th_percentile": 34.38, "90th_percentile": 34.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 44.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 44.8, "10th_percentile": 44.8, "90th_percentile": 44.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 48.72, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 48.72, "10th_percentile": 48.72, "90th_percentile": 48.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 36.4, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 36.4, "10th_percentile": 36.4, "90th_percentile": 36.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 36.4, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 36.4, "10th_percentile": 36.4, "90th_percentile": 36.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 36.4, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 36.4, "10th_percentile": 36.4, "90th_percentile": 36.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 33.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 33.6, "10th_percentile": 33.6, "90th_percentile": 33.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 33.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 33.6, "10th_percentile": 33.6, "90th_percentile": 33.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 34.38, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 34.38, "10th_percentile": 34.38, "90th_percentile": 34.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 32.73, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 32.73, "10th_percentile": 32.73, "90th_percentile": 32.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 31.3, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 31.3, "10th_percentile": 31.3, "90th_percentile": 31.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 30.52, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 30.52, "10th_percentile": 30.52, "90th_percentile": 30.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 30.52, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 30.52, "10th_percentile": 30.52, "90th_percentile": 30.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 30.52, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 30.52, "10th_percentile": 30.52, "90th_percentile": 30.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 56.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 56.0, "10th_percentile": 56.0, "90th_percentile": 56.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 56.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 56.0, "10th_percentile": 56.0, "90th_percentile": 56.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 56.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 56.0, "10th_percentile": 56.0, "90th_percentile": 56.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 56.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 56.0, "10th_percentile": 56.0, "90th_percentile": 56.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 56.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 56.0, "10th_percentile": 56.0, "90th_percentile": 56.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Als1-Emergency", "code_information": [ { "code": "PX-54000002", "type": "CDM" }, { "code": "A0427", "type": "HCPCS" }, { "code": "0540", "type": "RC" } ], "standard_charges": [ { "minimum": 1351.98, "maximum": 3219.0, "setting": "outpatient", "gross_charge": 3219.0, "discounted_cash": 2253.3, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_algorithm": "No contract line matched", "median_amount": 3219.0, "10th_percentile": 3219.0, "90th_percentile": 3219.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 3219.0, "10th_percentile": 3219.0, "90th_percentile": 3219.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3219.0, "10th_percentile": 3219.0, "90th_percentile": 3219.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3219.0, "10th_percentile": 3219.0, "90th_percentile": 3219.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3219.0, "10th_percentile": 3219.0, "90th_percentile": 3219.0, "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": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2092.35, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1931.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2092.35, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2092.35, "10th_percentile": 2092.35, "90th_percentile": 2092.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1799.42, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 1799.42, "10th_percentile": 1799.42, "90th_percentile": 1799.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 1931.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1931.4, "10th_percentile": 1931.4, "90th_percentile": 1931.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1881.18, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1881.18, "10th_percentile": 1881.18, "90th_percentile": 1881.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1931.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 1931.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1931.4, "10th_percentile": 1931.4, "90th_percentile": 1931.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 1931.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1931.4, "10th_percentile": 1931.4, "90th_percentile": 1931.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 1609.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 1609.5, "10th_percentile": 1609.5, "90th_percentile": 1609.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1512.93, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1512.93, "10th_percentile": 1512.93, "90th_percentile": 1512.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 1749.53, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 1749.53, "10th_percentile": 1749.53, "90th_percentile": 1749.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1881.18, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1881.18, "10th_percentile": 1881.18, "90th_percentile": 1881.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 2800.53, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 2800.53, "10th_percentile": 2800.53, "90th_percentile": 2800.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2027.97, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2027.97, "10th_percentile": 2027.97, "90th_percentile": 2027.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2153.51, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2153.51, "10th_percentile": 2153.51, "90th_percentile": 2153.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH PHCS", "standard_charge_dollar": 2575.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 2575.2, "10th_percentile": 2575.2, "90th_percentile": 2575.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 2092.35, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 2092.35, "10th_percentile": 2092.35, "90th_percentile": 2092.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1351.98, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1351.98, "10th_percentile": 1351.98, "90th_percentile": 1351.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1351.98, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1351.98, "10th_percentile": 1351.98, "90th_percentile": 1351.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3219.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3219.0, "10th_percentile": 3219.0, "90th_percentile": 3219.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3219.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3219.0, "10th_percentile": 3219.0, "90th_percentile": 3219.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3219.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3219.0, "10th_percentile": 3219.0, "90th_percentile": 3219.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3219.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3219.0, "10th_percentile": 3219.0, "90th_percentile": 3219.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3219.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3219.0, "10th_percentile": 3219.0, "90th_percentile": 3219.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Ammonia", "code_information": [ { "code": "PX-30105068", "type": "CDM" }, { "code": "82140", "type": "CPT" }, { "code": "0301", "type": "RC" } ], "standard_charges": [ { "minimum": 42.84, "maximum": 102.0, "setting": "outpatient", "gross_charge": 102.0, "discounted_cash": 71.4, "payers_information": [ { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_algorithm": "No contract line matched", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_algorithm": "No contract line matched", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_algorithm": "No contract line matched", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_algorithm": "No contract line matched", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_algorithm": "No contract line matched", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH AETNA", "standard_charge_algorithm": "No contract line matched", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_algorithm": "No contract line matched", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $102.00 @ 12.5% = $12.75 due to $0.00 Claim Price", "median_amount": 12.75, "10th_percentile": 12.75, "90th_percentile": 12.75, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $102.00 @ 12.5% = $12.75 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $102.00 @ 12.5% = $12.75 due to $0.00 Claim Price", "median_amount": 12.75, "10th_percentile": 12.75, "90th_percentile": 12.75, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $102.00 @ 12.5% = $12.75 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $102.00 @ 12.5% = $12.75 due to $0.00 Claim Price", "median_amount": 12.75, "10th_percentile": 12.75, "90th_percentile": 12.75, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $102.00 @ 12.5% = $12.75 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 42.84, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 42.84, "10th_percentile": 42.84, "90th_percentile": 42.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 42.84, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 42.84, "10th_percentile": 42.84, "90th_percentile": 42.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 61.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 61.2, "10th_percentile": 61.2, "90th_percentile": 61.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 47.94, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 47.94, "10th_percentile": 47.94, "90th_percentile": 47.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 64.26, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 64.26, "10th_percentile": 64.26, "90th_percentile": 64.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 55.44, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 55.44, "10th_percentile": 55.44, "90th_percentile": 55.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 51.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 51.0, "10th_percentile": 51.0, "90th_percentile": 51.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 59.61, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.61, "10th_percentile": 59.61, "90th_percentile": 59.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 62.63, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 62.63, "10th_percentile": 62.63, "90th_percentile": 62.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 62.63, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 62.63, "10th_percentile": 62.63, "90th_percentile": 62.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 59.61, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.61, "10th_percentile": 59.61, "90th_percentile": 59.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 57.02, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 57.02, "10th_percentile": 57.02, "90th_percentile": 57.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 55.59, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 55.59, "10th_percentile": 55.59, "90th_percentile": 55.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 55.59, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 55.59, "10th_percentile": 55.59, "90th_percentile": 55.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 55.59, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 55.59, "10th_percentile": 55.59, "90th_percentile": 55.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Anoscopy Dx W/HRA &Chem Agnts Enhancement W/Bx", "code_information": [ { "code": "PX-76100405", "type": "CDM" }, { "code": "46607", "type": "CPT" }, { "code": "0761", "type": "RC" } ], "standard_charges": [ { "minimum": 2241.54, "maximum": 5337.0, "setting": "outpatient", "gross_charge": 5337.0, "discounted_cash": 3735.9, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,337.00 @ 12.5% = $667.13 due to $0.00 Claim Price", "median_amount": 667.13, "10th_percentile": 667.13, "90th_percentile": 667.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,337.00 @ 12.5% = $667.13 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,337.00 @ 12.5% = $667.13 due to $0.00 Claim Price", "median_amount": 667.13, "10th_percentile": 667.13, "90th_percentile": 667.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,337.00 @ 12.5% = $667.13 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,337.00 @ 12.5% = $667.13 due to $0.00 Claim Price", "median_amount": 667.13, "10th_percentile": 667.13, "90th_percentile": 667.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,337.00 @ 12.5% = $667.13 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3202.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 3469.05, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3276.92, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3276.92, "10th_percentile": 3276.92, "90th_percentile": 3276.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 3202.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3202.2, "10th_percentile": 3202.2, "90th_percentile": 3202.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2983.38, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2983.38, "10th_percentile": 2983.38, "90th_percentile": 2983.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3118.94, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3118.94, "10th_percentile": 3118.94, "90th_percentile": 3118.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2908.67, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2908.67, "10th_percentile": 2908.67, "90th_percentile": 2908.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2908.67, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2908.67, "10th_percentile": 2908.67, "90th_percentile": 2908.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2908.67, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2908.67, "10th_percentile": 2908.67, "90th_percentile": 2908.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2241.54, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2241.54, "10th_percentile": 2241.54, "90th_percentile": 2241.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2241.54, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2241.54, "10th_percentile": 2241.54, "90th_percentile": 2241.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3276.92, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3276.92, "10th_percentile": 3276.92, "90th_percentile": 3276.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 4269.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 4269.6, "10th_percentile": 4269.6, "90th_percentile": 4269.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 3570.45, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3570.45, "10th_percentile": 3570.45, "90th_percentile": 3570.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 4643.19, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 4643.19, "10th_percentile": 4643.19, "90th_percentile": 4643.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3118.94, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3118.94, "10th_percentile": 3118.94, "90th_percentile": 3118.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH THE ALLIANCE", "standard_charge_dollar": 2900.66, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2900.66, "10th_percentile": 2900.66, "90th_percentile": 2900.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 3362.31, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 3362.31, "10th_percentile": 3362.31, "90th_percentile": 3362.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2508.39, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2508.39, "10th_percentile": 2508.39, "90th_percentile": 2508.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2668.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2668.5, "10th_percentile": 2668.5, "90th_percentile": 2668.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH DREYER - IPA", "standard_charge_dollar": 3202.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3202.2, "10th_percentile": 3202.2, "90th_percentile": 3202.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 3202.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3202.2, "10th_percentile": 3202.2, "90th_percentile": 3202.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3202.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5337.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5337.0, "10th_percentile": 5337.0, "90th_percentile": 5337.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5337.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5337.0, "10th_percentile": 5337.0, "90th_percentile": 5337.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5337.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5337.0, "10th_percentile": 5337.0, "90th_percentile": 5337.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5337.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5337.0, "10th_percentile": 5337.0, "90th_percentile": 5337.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5337.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5337.0, "10th_percentile": 5337.0, "90th_percentile": 5337.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Antimicrobial Dressing", "code_information": [ { "code": "PX-27205001", "type": "CDM" }, { "code": "27205001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 38.64, "maximum": 92.0, "setting": "outpatient", "gross_charge": 92.0, "discounted_cash": 64.4, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "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": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "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": "MRH MEDICARE", "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": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 59.8, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 55.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 55.2, "10th_percentile": 55.2, "90th_percentile": 55.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 53.07, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 53.07, "10th_percentile": 53.07, "90th_percentile": 53.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 46.88, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 46.88, "10th_percentile": 46.88, "90th_percentile": 46.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 59.8, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 59.8, "10th_percentile": 59.8, "90th_percentile": 59.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 51.43, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 51.43, "10th_percentile": 51.43, "90th_percentile": 51.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 55.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 55.2, "10th_percentile": 55.2, "90th_percentile": 55.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 53.76, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 53.76, "10th_percentile": 53.76, "90th_percentile": 53.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 44.65, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 44.65, "10th_percentile": 44.65, "90th_percentile": 44.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 44.65, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 44.65, "10th_percentile": 44.65, "90th_percentile": 44.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 55.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 55.2, "10th_percentile": 55.2, "90th_percentile": 55.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 55.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 55.2, "10th_percentile": 55.2, "90th_percentile": 55.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 55.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 55.2, "10th_percentile": 55.2, "90th_percentile": 55.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 57.96, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 57.96, "10th_percentile": 57.96, "90th_percentile": 57.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 43.24, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 43.24, "10th_percentile": 43.24, "90th_percentile": 43.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 59.8, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 59.8, "10th_percentile": 59.8, "90th_percentile": 59.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 50.0, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 50.0, "10th_percentile": 50.0, "90th_percentile": 50.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 80.04, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 80.04, "10th_percentile": 80.04, "90th_percentile": 80.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 61.55, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 61.55, "10th_percentile": 61.55, "90th_percentile": 61.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS HMO", "standard_charge_dollar": 53.76, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 53.76, "10th_percentile": 53.76, "90th_percentile": 53.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH PHCS", "standard_charge_dollar": 73.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 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 Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 53.07, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 53.07, "10th_percentile": 53.07, "90th_percentile": 53.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 46.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 46.0, "10th_percentile": 46.0, "90th_percentile": 46.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH UHC ALL OTHER", "standard_charge_dollar": 44.71, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 44.62, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.62, "10th_percentile": 44.62, "90th_percentile": 44.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 38.64, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 38.64, "10th_percentile": 38.64, "90th_percentile": 38.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 38.64, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 38.64, "10th_percentile": 38.64, "90th_percentile": 38.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH 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": "MULTIPLAN/PHCS [142]", "plan_name": "MRH 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": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH 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" } ] } ] }, { "description": "HB Antithrombin III Activity", "code_information": [ { "code": "PX-30512090", "type": "CDM" }, { "code": "85300", "type": "CPT" }, { "code": "0305", "type": "RC" } ], "standard_charges": [ { "minimum": 98.28, "maximum": 234.0, "setting": "outpatient", "gross_charge": 234.0, "discounted_cash": 163.8, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH AETNA", "standard_charge_algorithm": "No contract line matched", "median_amount": 234.0, "10th_percentile": 234.0, "90th_percentile": 234.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_algorithm": "No contract line matched", "median_amount": 234.0, "10th_percentile": 234.0, "90th_percentile": 234.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $234.00 @ 12.5% = $29.25 due to $0.00 Claim Price", "median_amount": 29.25, "10th_percentile": 29.25, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $234.00 @ 12.5% = $29.25 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $234.00 @ 12.5% = $29.25 due to $0.00 Claim Price", "median_amount": 29.25, "10th_percentile": 29.25, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $234.00 @ 12.5% = $29.25 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $234.00 @ 12.5% = $29.25 due to $0.00 Claim Price", "median_amount": 29.25, "10th_percentile": 29.25, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $234.00 @ 12.5% = $29.25 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 152.1, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 152.1, "10th_percentile": 152.1, "90th_percentile": 152.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 140.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 152.1, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 152.1, "10th_percentile": 152.1, "90th_percentile": 152.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 143.68, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 143.68, "10th_percentile": 143.68, "90th_percentile": 143.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 140.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 130.81, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 130.81, "10th_percentile": 130.81, "90th_percentile": 130.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 136.75, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 136.75, "10th_percentile": 136.75, "90th_percentile": 136.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 127.53, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 127.53, "10th_percentile": 127.53, "90th_percentile": 127.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 127.53, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 127.53, "10th_percentile": 127.53, "90th_percentile": 127.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 127.53, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 127.53, "10th_percentile": 127.53, "90th_percentile": 127.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 98.28, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 98.28, "10th_percentile": 98.28, "90th_percentile": 98.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 98.28, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 98.28, "10th_percentile": 98.28, "90th_percentile": 98.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 152.1, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 152.1, "10th_percentile": 152.1, "90th_percentile": 152.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 143.68, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 143.68, "10th_percentile": 143.68, "90th_percentile": 143.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 117.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 117.0, "10th_percentile": 117.0, "90th_percentile": 117.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 156.55, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 156.55, "10th_percentile": 156.55, "90th_percentile": 156.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 203.58, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 203.58, "10th_percentile": 203.58, "90th_percentile": 203.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 187.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 187.2, "10th_percentile": 187.2, "90th_percentile": 187.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 136.75, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 136.75, "10th_percentile": 136.75, "90th_percentile": 136.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 147.42, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 147.42, "10th_percentile": 147.42, "90th_percentile": 147.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 109.98, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 109.98, "10th_percentile": 109.98, "90th_percentile": 109.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 127.18, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 127.18, "10th_percentile": 127.18, "90th_percentile": 127.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 140.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "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 Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 140.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 140.4, "10th_percentile": 140.4, "90th_percentile": 140.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 140.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% 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 Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 234.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 234.0, "10th_percentile": 234.0, "90th_percentile": 234.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 234.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 234.0, "10th_percentile": 234.0, "90th_percentile": 234.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 234.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 234.0, "10th_percentile": 234.0, "90th_percentile": 234.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 234.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 234.0, "10th_percentile": 234.0, "90th_percentile": 234.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 234.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 234.0, "10th_percentile": 234.0, "90th_percentile": 234.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Aortography Thoracic by Serialography; S&I", "code_information": [ { "code": "PX-32300007", "type": "CDM" }, { "code": "75605", "type": "CPT" }, { "code": "0323", "type": "RC" } ], "standard_charges": [ { "minimum": 4085.76, "maximum": 9728.0, "setting": "outpatient", "gross_charge": 9728.0, "discounted_cash": 6809.6, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 9728.0, "10th_percentile": 9728.0, "90th_percentile": 9728.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 9728.0, "10th_percentile": 9728.0, "90th_percentile": 9728.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 9728.0, "10th_percentile": 9728.0, "90th_percentile": 9728.0, "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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 5836.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 6323.2, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 5836.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 5836.8, "10th_percentile": 5836.8, "90th_percentile": 5836.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 5437.95, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 5437.95, "10th_percentile": 5437.95, "90th_percentile": 5437.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 5685.04, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5685.04, "10th_percentile": 5685.04, "90th_percentile": 5685.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 4085.76, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 4085.76, "10th_percentile": 4085.76, "90th_percentile": 4085.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 4085.76, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 4085.76, "10th_percentile": 4085.76, "90th_percentile": 4085.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 4864.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 4864.0, "10th_percentile": 4864.0, "90th_percentile": 4864.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 6508.03, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6508.03, "10th_percentile": 6508.03, "90th_percentile": 6508.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 8463.36, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 8463.36, "10th_percentile": 8463.36, "90th_percentile": 8463.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 7782.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 7782.4, "10th_percentile": 7782.4, "90th_percentile": 7782.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 5685.04, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5685.04, "10th_percentile": 5685.04, "90th_percentile": 5685.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 6128.64, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 6128.64, "10th_percentile": 6128.64, "90th_percentile": 6128.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 4572.16, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 4572.16, "10th_percentile": 4572.16, "90th_percentile": 4572.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 5287.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 5287.17, "10th_percentile": 5287.17, "90th_percentile": 5287.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 5836.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 5836.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5836.8, "10th_percentile": 5836.8, "90th_percentile": 5836.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 5836.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 5836.8, "10th_percentile": 5836.8, "90th_percentile": 5836.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9728.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9728.0, "10th_percentile": 9728.0, "90th_percentile": 9728.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9728.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9728.0, "10th_percentile": 9728.0, "90th_percentile": 9728.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9728.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9728.0, "10th_percentile": 9728.0, "90th_percentile": 9728.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9728.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9728.0, "10th_percentile": 9728.0, "90th_percentile": 9728.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9728.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9728.0, "10th_percentile": 9728.0, "90th_percentile": 9728.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Apheresis Plasma", "code_information": [ { "code": "PX-94000003", "type": "CDM" }, { "code": "36514", "type": "CPT" }, { "code": "0940", "type": "RC" } ], "standard_charges": [ { "minimum": 3188.22, "maximum": 7591.0, "setting": "outpatient", "gross_charge": 7591.0, "discounted_cash": 5313.7, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_algorithm": "No contract line matched", "median_amount": 7591.0, "10th_percentile": 7591.0, "90th_percentile": 7591.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 7591.0, "10th_percentile": 7591.0, "90th_percentile": 7591.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,591.00 @ 12.5% = $948.88 due to $0.00 Claim Price", "median_amount": 948.88, "10th_percentile": 948.88, "90th_percentile": 948.88, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,591.00 @ 12.5% = $948.88 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,591.00 @ 12.5% = $948.88 due to $0.00 Claim Price", "median_amount": 948.88, "10th_percentile": 948.88, "90th_percentile": 948.88, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,591.00 @ 12.5% = $948.88 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,591.00 @ 12.5% = $948.88 due to $0.00 Claim Price", "median_amount": 948.88, "10th_percentile": 948.88, "90th_percentile": 948.88, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,591.00 @ 12.5% = $948.88 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 4554.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 4934.15, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 4660.87, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 4660.87, "10th_percentile": 4660.87, "90th_percentile": 4660.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 4554.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 4554.6, "10th_percentile": 4554.6, "90th_percentile": 4554.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 4243.37, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 4243.37, "10th_percentile": 4243.37, "90th_percentile": 4243.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 4436.18, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4436.18, "10th_percentile": 4436.18, "90th_percentile": 4436.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 4137.1, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 4137.1, "10th_percentile": 4137.1, "90th_percentile": 4137.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 4137.1, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 4137.1, "10th_percentile": 4137.1, "90th_percentile": 4137.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 4137.1, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 4137.1, "10th_percentile": 4137.1, "90th_percentile": 4137.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 3188.22, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 3188.22, "10th_percentile": 3188.22, "90th_percentile": 3188.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 3188.22, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 3188.22, "10th_percentile": 3188.22, "90th_percentile": 3188.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 4660.87, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 4660.87, "10th_percentile": 4660.87, "90th_percentile": 4660.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 3795.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 3795.5, "10th_percentile": 3795.5, "90th_percentile": 3795.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 5078.38, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5078.38, "10th_percentile": 5078.38, "90th_percentile": 5078.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 6604.17, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 6604.17, "10th_percentile": 6604.17, "90th_percentile": 6604.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 6072.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 6072.8, "10th_percentile": 6072.8, "90th_percentile": 6072.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 4436.18, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4436.18, "10th_percentile": 4436.18, "90th_percentile": 4436.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 4782.33, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 4782.33, "10th_percentile": 4782.33, "90th_percentile": 4782.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 3567.77, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 3567.77, "10th_percentile": 3567.77, "90th_percentile": 3567.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 4125.71, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 4125.71, "10th_percentile": 4125.71, "90th_percentile": 4125.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 4554.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 4554.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4554.6, "10th_percentile": 4554.6, "90th_percentile": 4554.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 4554.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 4554.6, "10th_percentile": 4554.6, "90th_percentile": 4554.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7591.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7591.0, "10th_percentile": 7591.0, "90th_percentile": 7591.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7591.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7591.0, "10th_percentile": 7591.0, "90th_percentile": 7591.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7591.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7591.0, "10th_percentile": 7591.0, "90th_percentile": 7591.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7591.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7591.0, "10th_percentile": 7591.0, "90th_percentile": 7591.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7591.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7591.0, "10th_percentile": 7591.0, "90th_percentile": 7591.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Application, Cast; Below Knees to Toes-Short Leg", "code_information": [ { "code": "PX-36100322", "type": "CDM" }, { "code": "29405", "type": "CPT" }, { "code": "0361", "type": "RC" } ], "standard_charges": [ { "minimum": 261.27, "maximum": 291.21, "setting": "outpatient", "gross_charge": 434.0, "discounted_cash": 303.8, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 261.27, "standard_charge_percentage": 60.2, "standard_charge_algorithm": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 261.27, "10th_percentile": 261.27, "90th_percentile": 261.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 291.21, "standard_charge_percentage": 67.1, "standard_charge_algorithm": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 291.21, "10th_percentile": 291.21, "90th_percentile": 291.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "HB Aqmbf Pet Rest and Pharmacologic Stress", "code_information": [ { "code": "PX-34000082", "type": "CDM" }, { "code": "78434", "type": "CPT" }, { "code": "0404", "type": "RC" } ], "standard_charges": [ { "minimum": 1774.5, "maximum": 4225.0, "setting": "outpatient", "gross_charge": 4225.0, "discounted_cash": 2957.5, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_algorithm": "No contract line matched", "median_amount": 4225.0, "10th_percentile": 4225.0, "90th_percentile": 4225.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 4225.0, "10th_percentile": 4225.0, "90th_percentile": 4225.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,225.00 @ 12.5% = $528.13 due to $0.00 Claim Price", "median_amount": 528.13, "10th_percentile": 528.13, "90th_percentile": 528.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,225.00 @ 12.5% = $528.13 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,225.00 @ 12.5% = $528.13 due to $0.00 Claim Price", "median_amount": 528.13, "10th_percentile": 528.13, "90th_percentile": 528.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,225.00 @ 12.5% = $528.13 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,225.00 @ 12.5% = $528.13 due to $0.00 Claim Price", "median_amount": 528.13, "10th_percentile": 528.13, "90th_percentile": 528.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,225.00 @ 12.5% = $528.13 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2535.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2746.25, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2594.15, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 2594.15, "10th_percentile": 2594.15, "90th_percentile": 2594.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2535.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 2535.0, "10th_percentile": 2535.0, "90th_percentile": 2535.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2361.78, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2361.78, "10th_percentile": 2361.78, "90th_percentile": 2361.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2469.09, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2469.09, "10th_percentile": 2469.09, "90th_percentile": 2469.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2302.63, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2302.63, "10th_percentile": 2302.63, "90th_percentile": 2302.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2302.63, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2302.63, "10th_percentile": 2302.63, "90th_percentile": 2302.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2302.63, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2302.63, "10th_percentile": 2302.63, "90th_percentile": 2302.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1774.5, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1774.5, "10th_percentile": 1774.5, "90th_percentile": 1774.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1774.5, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1774.5, "10th_percentile": 1774.5, "90th_percentile": 1774.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2594.15, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 2594.15, "10th_percentile": 2594.15, "90th_percentile": 2594.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2112.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2112.5, "10th_percentile": 2112.5, "90th_percentile": 2112.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2826.53, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2826.53, "10th_percentile": 2826.53, "90th_percentile": 2826.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3675.75, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3675.75, "10th_percentile": 3675.75, "90th_percentile": 3675.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3380.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 3380.0, "10th_percentile": 3380.0, "90th_percentile": 3380.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2469.09, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2469.09, "10th_percentile": 2469.09, "90th_percentile": 2469.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2661.75, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2661.75, "10th_percentile": 2661.75, "90th_percentile": 2661.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1985.75, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1985.75, "10th_percentile": 1985.75, "90th_percentile": 1985.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2296.29, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2296.29, "10th_percentile": 2296.29, "90th_percentile": 2296.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2535.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2535.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2535.0, "10th_percentile": 2535.0, "90th_percentile": 2535.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 2535.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 2535.0, "10th_percentile": 2535.0, "90th_percentile": 2535.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4225.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4225.0, "10th_percentile": 4225.0, "90th_percentile": 4225.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4225.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4225.0, "10th_percentile": 4225.0, "90th_percentile": 4225.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4225.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4225.0, "10th_percentile": 4225.0, "90th_percentile": 4225.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4225.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4225.0, "10th_percentile": 4225.0, "90th_percentile": 4225.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4225.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4225.0, "10th_percentile": 4225.0, "90th_percentile": 4225.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Artery X-Rays Chest", "code_information": [ { "code": "PX-32300012", "type": "CDM" }, { "code": "75756", "type": "CPT" }, { "code": "0323", "type": "RC" } ], "standard_charges": [ { "minimum": 1192.8, "maximum": 2840.0, "setting": "outpatient", "gross_charge": 2840.0, "discounted_cash": 1988.0, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,840.00 @ 12.5% = $355.00 due to $0.00 Claim Price", "median_amount": 355.0, "10th_percentile": 355.0, "90th_percentile": 355.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,840.00 @ 12.5% = $355.00 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,840.00 @ 12.5% = $355.00 due to $0.00 Claim Price", "median_amount": 355.0, "10th_percentile": 355.0, "90th_percentile": 355.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,840.00 @ 12.5% = $355.00 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,840.00 @ 12.5% = $355.00 due to $0.00 Claim Price", "median_amount": 355.0, "10th_percentile": 355.0, "90th_percentile": 355.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,840.00 @ 12.5% = $355.00 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1704.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 1846.0, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 1743.76, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 1743.76, "10th_percentile": 1743.76, "90th_percentile": 1743.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 1704.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1704.0, "10th_percentile": 1704.0, "90th_percentile": 1704.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1587.56, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 1587.56, "10th_percentile": 1587.56, "90th_percentile": 1587.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1659.7, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1659.7, "10th_percentile": 1659.7, "90th_percentile": 1659.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1547.8, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 1547.8, "10th_percentile": 1547.8, "90th_percentile": 1547.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1547.8, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 1547.8, "10th_percentile": 1547.8, "90th_percentile": 1547.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1547.8, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 1547.8, "10th_percentile": 1547.8, "90th_percentile": 1547.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1192.8, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1192.8, "10th_percentile": 1192.8, "90th_percentile": 1192.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1192.8, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1192.8, "10th_percentile": 1192.8, "90th_percentile": 1192.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 1743.76, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 1743.76, "10th_percentile": 1743.76, "90th_percentile": 1743.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 1420.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 1420.0, "10th_percentile": 1420.0, "90th_percentile": 1420.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 1899.96, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1899.96, "10th_percentile": 1899.96, "90th_percentile": 1899.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 2470.8, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 2470.8, "10th_percentile": 2470.8, "90th_percentile": 2470.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 2272.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 2272.0, "10th_percentile": 2272.0, "90th_percentile": 2272.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1659.7, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1659.7, "10th_percentile": 1659.7, "90th_percentile": 1659.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 1789.2, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 1789.2, "10th_percentile": 1789.2, "90th_percentile": 1789.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1334.8, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1334.8, "10th_percentile": 1334.8, "90th_percentile": 1334.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 1543.54, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 1543.54, "10th_percentile": 1543.54, "90th_percentile": 1543.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1704.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 1704.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1704.0, "10th_percentile": 1704.0, "90th_percentile": 1704.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 1704.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1704.0, "10th_percentile": 1704.0, "90th_percentile": 1704.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2840.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2840.0, "10th_percentile": 2840.0, "90th_percentile": 2840.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2840.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2840.0, "10th_percentile": 2840.0, "90th_percentile": 2840.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2840.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2840.0, "10th_percentile": 2840.0, "90th_percentile": 2840.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2840.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2840.0, "10th_percentile": 2840.0, "90th_percentile": 2840.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2840.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2840.0, "10th_percentile": 2840.0, "90th_percentile": 2840.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Aspiration of Tarlov Cyst With Fibrin Glue Treatment - Unlisted", "code_information": [ { "code": "PX-76100135", "type": "CDM" }, { "code": "64999", "type": "CPT" }, { "code": "0761", "type": "RC" } ], "standard_charges": [ { "minimum": 841.68, "maximum": 2004.0, "setting": "outpatient", "gross_charge": 2004.0, "discounted_cash": 1402.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,004.00 @ 12.5% = $250.50 due to $0.00 Claim Price", "median_amount": 250.5, "10th_percentile": 250.5, "90th_percentile": 250.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,004.00 @ 12.5% = $250.50 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,004.00 @ 12.5% = $250.50 due to $0.00 Claim Price", "median_amount": 250.5, "10th_percentile": 250.5, "90th_percentile": 250.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,004.00 @ 12.5% = $250.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,004.00 @ 12.5% = $250.50 due to $0.00 Claim Price", "median_amount": 250.5, "10th_percentile": 250.5, "90th_percentile": 250.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,004.00 @ 12.5% = $250.50 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1202.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 1302.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 1302.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 1302.6, "10th_percentile": 1302.6, "90th_percentile": 1302.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 1230.46, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 1230.46, "10th_percentile": 1230.46, "90th_percentile": 1230.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 1202.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1202.4, "10th_percentile": 1202.4, "90th_percentile": 1202.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1120.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 1120.24, "10th_percentile": 1120.24, "90th_percentile": 1120.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1171.14, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1171.14, "10th_percentile": 1171.14, "90th_percentile": 1171.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1092.18, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 1092.18, "10th_percentile": 1092.18, "90th_percentile": 1092.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1092.18, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 1092.18, "10th_percentile": 1092.18, "90th_percentile": 1092.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1092.18, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 1092.18, "10th_percentile": 1092.18, "90th_percentile": 1092.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 841.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 841.68, "10th_percentile": 841.68, "90th_percentile": 841.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 841.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 841.68, "10th_percentile": 841.68, "90th_percentile": 841.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 1302.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 1302.6, "10th_percentile": 1302.6, "90th_percentile": 1302.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 1230.46, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 1230.46, "10th_percentile": 1230.46, "90th_percentile": 1230.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 1603.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 1603.2, "10th_percentile": 1603.2, "90th_percentile": 1603.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 1340.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1340.68, "10th_percentile": 1340.68, "90th_percentile": 1340.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 1743.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 1743.48, "10th_percentile": 1743.48, "90th_percentile": 1743.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1171.14, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1171.14, "10th_percentile": 1171.14, "90th_percentile": 1171.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH THE ALLIANCE", "standard_charge_dollar": 1089.17, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 1089.17, "10th_percentile": 1089.17, "90th_percentile": 1089.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 1262.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 1262.52, "10th_percentile": 1262.52, "90th_percentile": 1262.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 941.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 941.88, "10th_percentile": 941.88, "90th_percentile": 941.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 1002.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 1002.0, "10th_percentile": 1002.0, "90th_percentile": 1002.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH DREYER - IPA", "standard_charge_dollar": 1202.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1202.4, "10th_percentile": 1202.4, "90th_percentile": 1202.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 1202.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1202.4, "10th_percentile": 1202.4, "90th_percentile": 1202.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1202.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2004.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2004.0, "10th_percentile": 2004.0, "90th_percentile": 2004.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2004.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2004.0, "10th_percentile": 2004.0, "90th_percentile": 2004.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2004.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2004.0, "10th_percentile": 2004.0, "90th_percentile": 2004.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2004.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2004.0, "10th_percentile": 2004.0, "90th_percentile": 2004.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2004.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2004.0, "10th_percentile": 2004.0, "90th_percentile": 2004.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Automated Leukocyte Count", "code_information": [ { "code": "PX-30511010", "type": "CDM" }, { "code": "85048", "type": "CPT" }, { "code": "0305", "type": "RC" } ], "standard_charges": [ { "minimum": 11.76, "maximum": 28.0, "setting": "outpatient", "gross_charge": 28.0, "discounted_cash": 19.6, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $28.00 @ 12.5% = $3.50 due to $0.00 Claim Price", "median_amount": 3.5, "10th_percentile": 3.5, "90th_percentile": 3.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $28.00 @ 12.5% = $3.50 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $28.00 @ 12.5% = $3.50 due to $0.00 Claim Price", "median_amount": 3.5, "10th_percentile": 3.5, "90th_percentile": 3.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $28.00 @ 12.5% = $3.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $28.00 @ 12.5% = $3.50 due to $0.00 Claim Price", "median_amount": 3.5, "10th_percentile": 3.5, "90th_percentile": 3.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $28.00 @ 12.5% = $3.50 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 18.2, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "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 Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 16.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 16.8, "10th_percentile": 16.8, "90th_percentile": 16.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 18.2, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 18.2, "10th_percentile": 18.2, "90th_percentile": 18.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 17.19, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 17.19, "10th_percentile": 17.19, "90th_percentile": 17.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 16.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 16.8, "10th_percentile": 16.8, "90th_percentile": 16.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 15.65, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 15.65, "10th_percentile": 15.65, "90th_percentile": 15.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 16.36, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 16.36, "10th_percentile": 16.36, "90th_percentile": 16.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 15.26, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 15.26, "10th_percentile": 15.26, "90th_percentile": 15.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 15.26, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 15.26, "10th_percentile": 15.26, "90th_percentile": 15.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 15.26, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 15.26, "10th_percentile": 15.26, "90th_percentile": 15.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 11.76, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 11.76, "10th_percentile": 11.76, "90th_percentile": 11.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 11.76, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 11.76, "10th_percentile": 11.76, "90th_percentile": 11.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 18.2, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 18.2, "10th_percentile": 18.2, "90th_percentile": 18.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 17.19, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 17.19, "10th_percentile": 17.19, "90th_percentile": 17.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 14.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 14.0, "10th_percentile": 14.0, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 18.73, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.73, "10th_percentile": 18.73, "90th_percentile": 18.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 24.36, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 24.36, "10th_percentile": 24.36, "90th_percentile": 24.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 22.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 22.4, "10th_percentile": 22.4, "90th_percentile": 22.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 16.36, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 16.36, "10th_percentile": 16.36, "90th_percentile": 16.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 17.64, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 17.64, "10th_percentile": 17.64, "90th_percentile": 17.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 13.16, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 13.16, "10th_percentile": 13.16, "90th_percentile": 13.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 15.22, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 15.22, "10th_percentile": 15.22, "90th_percentile": 15.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 16.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 16.8, "10th_percentile": 16.8, "90th_percentile": 16.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 16.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 16.8, "10th_percentile": 16.8, "90th_percentile": 16.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 16.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 16.8, "10th_percentile": 16.8, "90th_percentile": 16.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 28.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 28.0, "10th_percentile": 28.0, "90th_percentile": 28.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 28.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 28.0, "10th_percentile": 28.0, "90th_percentile": 28.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 28.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 28.0, "10th_percentile": 28.0, "90th_percentile": 28.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 28.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 28.0, "10th_percentile": 28.0, "90th_percentile": 28.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 28.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 28.0, "10th_percentile": 28.0, "90th_percentile": 28.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Autonomic Nrv Adrenrg Inervj", "code_information": [ { "code": "PX-92200019", "type": "CDM" }, { "code": "95922", "type": "CPT" }, { "code": "0922", "type": "RC" } ], "standard_charges": [ { "minimum": 571.62, "maximum": 1361.0, "setting": "outpatient", "gross_charge": 1361.0, "discounted_cash": 952.7, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,361.00 @ 12.5% = $170.13 due to $0.00 Claim Price", "median_amount": 170.13, "10th_percentile": 170.13, "90th_percentile": 170.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,361.00 @ 12.5% = $170.13 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,361.00 @ 12.5% = $170.13 due to $0.00 Claim Price", "median_amount": 170.13, "10th_percentile": 170.13, "90th_percentile": 170.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,361.00 @ 12.5% = $170.13 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,361.00 @ 12.5% = $170.13 due to $0.00 Claim Price", "median_amount": 170.13, "10th_percentile": 170.13, "90th_percentile": 170.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,361.00 @ 12.5% = $170.13 due to $0.00 Claim Price" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_algorithm": "Electrommyelogram; Not Paid", "median_amount": 1361.0, "10th_percentile": 1361.0, "90th_percentile": 1361.0, "count": "0", "methodology": "other", "additional_payer_notes": "Electrommyelogram; Not Paid" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "Electrommyelogram; Not Paid", "median_amount": 1361.0, "10th_percentile": 1361.0, "90th_percentile": 1361.0, "count": "0", "methodology": "other", "additional_payer_notes": "Electrommyelogram; Not Paid" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 816.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 884.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 835.65, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 835.65, "10th_percentile": 835.65, "90th_percentile": 835.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 816.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 816.6, "10th_percentile": 816.6, "90th_percentile": 816.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 760.8, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 760.8, "10th_percentile": 760.8, "90th_percentile": 760.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 795.37, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 795.37, "10th_percentile": 795.37, "90th_percentile": 795.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 741.75, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 741.75, "10th_percentile": 741.75, "90th_percentile": 741.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 741.75, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 741.75, "10th_percentile": 741.75, "90th_percentile": 741.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 741.75, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 741.75, "10th_percentile": 741.75, "90th_percentile": 741.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 571.62, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 571.62, "10th_percentile": 571.62, "90th_percentile": 571.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 571.62, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 571.62, "10th_percentile": 571.62, "90th_percentile": 571.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 835.65, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 835.65, "10th_percentile": 835.65, "90th_percentile": 835.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 680.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 680.5, "10th_percentile": 680.5, "90th_percentile": 680.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 910.51, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 910.51, "10th_percentile": 910.51, "90th_percentile": 910.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 1184.07, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 1184.07, "10th_percentile": 1184.07, "90th_percentile": 1184.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 1088.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 1088.8, "10th_percentile": 1088.8, "90th_percentile": 1088.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 795.37, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 795.37, "10th_percentile": 795.37, "90th_percentile": 795.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 857.43, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 857.43, "10th_percentile": 857.43, "90th_percentile": 857.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 639.67, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 639.67, "10th_percentile": 639.67, "90th_percentile": 639.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 739.7, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 739.7, "10th_percentile": 739.7, "90th_percentile": 739.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 816.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 816.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 816.6, "10th_percentile": 816.6, "90th_percentile": 816.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 816.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 816.6, "10th_percentile": 816.6, "90th_percentile": 816.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1361.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1361.0, "10th_percentile": 1361.0, "90th_percentile": 1361.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1361.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1361.0, "10th_percentile": 1361.0, "90th_percentile": 1361.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1361.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1361.0, "10th_percentile": 1361.0, "90th_percentile": 1361.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1361.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1361.0, "10th_percentile": 1361.0, "90th_percentile": 1361.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1361.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1361.0, "10th_percentile": 1361.0, "90th_percentile": 1361.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Avf by Tissue W Thermal E", "code_information": [ { "code": "PX-36101028", "type": "CDM" }, { "code": "G2170", "type": "HCPCS" }, { "code": "0361", "type": "RC" } ], "standard_charges": [ { "minimum": 12420.66, "maximum": 29573.0, "setting": "outpatient", "gross_charge": 29573.0, "discounted_cash": 20701.1, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_algorithm": "No contract line matched", "median_amount": 29573.0, "10th_percentile": 29573.0, "90th_percentile": 29573.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 29573.0, "10th_percentile": 29573.0, "90th_percentile": 29573.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29573.0, "10th_percentile": 29573.0, "90th_percentile": 29573.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29573.0, "10th_percentile": 29573.0, "90th_percentile": 29573.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29573.0, "10th_percentile": 29573.0, "90th_percentile": 29573.0, "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": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 19222.45, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 17743.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 17057.71, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 17057.71, "10th_percentile": 17057.71, "90th_percentile": 17057.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 15070.4, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 15070.4, "10th_percentile": 15070.4, "90th_percentile": 15070.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 19222.45, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 19222.45, "10th_percentile": 19222.45, "90th_percentile": 19222.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 16531.31, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 16531.31, "10th_percentile": 16531.31, "90th_percentile": 16531.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 17743.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 17743.8, "10th_percentile": 17743.8, "90th_percentile": 17743.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 17282.46, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17282.46, "10th_percentile": 17282.46, "90th_percentile": 17282.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 14351.78, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 14351.78, "10th_percentile": 14351.78, "90th_percentile": 14351.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 14351.78, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 14351.78, "10th_percentile": 14351.78, "90th_percentile": 14351.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 17743.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 17743.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 17743.8, "10th_percentile": 17743.8, "90th_percentile": 17743.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 17743.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17743.8, "10th_percentile": 17743.8, "90th_percentile": 17743.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 14786.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 14786.5, "10th_percentile": 14786.5, "90th_percentile": 14786.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 13899.31, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 13899.31, "10th_percentile": 13899.31, "90th_percentile": 13899.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 16072.93, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 16072.93, "10th_percentile": 16072.93, "90th_percentile": 16072.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 17282.46, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17282.46, "10th_percentile": 17282.46, "90th_percentile": 17282.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 25728.51, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 25728.51, "10th_percentile": 25728.51, "90th_percentile": 25728.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 18630.99, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 18630.99, "10th_percentile": 18630.99, "90th_percentile": 18630.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 19784.34, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 19784.34, "10th_percentile": 19784.34, "90th_percentile": 19784.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH PHCS", "standard_charge_dollar": 23658.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 23658.4, "10th_percentile": 23658.4, "90th_percentile": 23658.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 19222.45, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 19222.45, "10th_percentile": 19222.45, "90th_percentile": 19222.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 17057.71, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 17057.71, "10th_percentile": 17057.71, "90th_percentile": 17057.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 12420.66, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 12420.66, "10th_percentile": 12420.66, "90th_percentile": 12420.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 12420.66, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 12420.66, "10th_percentile": 12420.66, "90th_percentile": 12420.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 29573.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 29573.0, "10th_percentile": 29573.0, "90th_percentile": 29573.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 29573.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 29573.0, "10th_percentile": 29573.0, "90th_percentile": 29573.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 29573.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 29573.0, "10th_percentile": 29573.0, "90th_percentile": 29573.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 29573.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 29573.0, "10th_percentile": 29573.0, "90th_percentile": 29573.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 29573.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 29573.0, "10th_percentile": 29573.0, "90th_percentile": 29573.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB B-Type Natriuretic Peptide (Bnp)", "code_information": [ { "code": "PX-30105119", "type": "CDM" }, { "code": "83880", "type": "CPT" }, { "code": "0301", "type": "RC" } ], "standard_charges": [ { "minimum": 89.46, "maximum": 213.0, "setting": "outpatient", "gross_charge": 213.0, "discounted_cash": 149.1, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH AETNA", "standard_charge_algorithm": "No contract line matched", "median_amount": 213.0, "10th_percentile": 213.0, "90th_percentile": 213.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_algorithm": "No contract line matched", "median_amount": 213.0, "10th_percentile": 213.0, "90th_percentile": 213.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $213.00 @ 12.5% = $26.63 due to $0.00 Claim Price", "median_amount": 26.63, "10th_percentile": 26.63, "90th_percentile": 26.63, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $213.00 @ 12.5% = $26.63 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $213.00 @ 12.5% = $26.63 due to $0.00 Claim Price", "median_amount": 26.63, "10th_percentile": 26.63, "90th_percentile": 26.63, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $213.00 @ 12.5% = $26.63 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $213.00 @ 12.5% = $26.63 due to $0.00 Claim Price", "median_amount": 26.63, "10th_percentile": 26.63, "90th_percentile": 26.63, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $213.00 @ 12.5% = $26.63 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 89.46, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 89.46, "10th_percentile": 89.46, "90th_percentile": 89.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 89.46, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 89.46, "10th_percentile": 89.46, "90th_percentile": 89.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 127.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 127.8, "10th_percentile": 127.8, "90th_percentile": 127.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 127.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 127.8, "10th_percentile": 127.8, "90th_percentile": 127.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 127.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 127.8, "10th_percentile": 127.8, "90th_percentile": 127.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 100.11, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 100.11, "10th_percentile": 100.11, "90th_percentile": 100.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 134.19, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 134.19, "10th_percentile": 134.19, "90th_percentile": 134.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 115.77, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 115.77, "10th_percentile": 115.77, "90th_percentile": 115.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 106.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 106.5, "10th_percentile": 106.5, "90th_percentile": 106.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 124.48, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 124.48, "10th_percentile": 124.48, "90th_percentile": 124.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 130.78, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 130.78, "10th_percentile": 130.78, "90th_percentile": 130.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 170.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 170.4, "10th_percentile": 170.4, "90th_percentile": 170.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 185.31, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 185.31, "10th_percentile": 185.31, "90th_percentile": 185.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 138.45, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 138.45, "10th_percentile": 138.45, "90th_percentile": 138.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 142.5, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 142.5, "10th_percentile": 142.5, "90th_percentile": 142.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 138.45, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 138.45, "10th_percentile": 138.45, "90th_percentile": 138.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 138.45, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 138.45, "10th_percentile": 138.45, "90th_percentile": 138.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 127.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 127.8, "10th_percentile": 127.8, "90th_percentile": 127.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 127.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 127.8, "10th_percentile": 127.8, "90th_percentile": 127.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 130.78, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 130.78, "10th_percentile": 130.78, "90th_percentile": 130.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 124.48, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 124.48, "10th_percentile": 124.48, "90th_percentile": 124.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 119.07, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 119.07, "10th_percentile": 119.07, "90th_percentile": 119.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 116.09, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 116.09, "10th_percentile": 116.09, "90th_percentile": 116.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 116.09, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 116.09, "10th_percentile": 116.09, "90th_percentile": 116.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 116.09, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 116.09, "10th_percentile": 116.09, "90th_percentile": 116.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 213.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% 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 OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 213.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% 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 OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 213.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% 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 OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 213.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% 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 OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 213.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% 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 OP Services; 100% Billed" } ] } ] }, { "description": "HB Behavior Counsel Obesity 15m", "code_information": [ { "code": "PX-94000032", "type": "CDM" }, { "code": "G0447", "type": "CPT" }, { "code": "0940", "type": "RC" } ], "standard_charges": [ { "minimum": 63.0, "maximum": 150.0, "setting": "outpatient", "gross_charge": 150.0, "discounted_cash": 105.0, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_algorithm": "No contract line matched", "median_amount": 150.0, "10th_percentile": 150.0, "90th_percentile": 150.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 150.0, "10th_percentile": 150.0, "90th_percentile": 150.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $150.00 @ 12.5% = $18.75 due to $0.00 Claim Price", "median_amount": 18.75, "10th_percentile": 18.75, "90th_percentile": 18.75, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $150.00 @ 12.5% = $18.75 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $150.00 @ 12.5% = $18.75 due to $0.00 Claim Price", "median_amount": 18.75, "10th_percentile": 18.75, "90th_percentile": 18.75, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $150.00 @ 12.5% = $18.75 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $150.00 @ 12.5% = $18.75 due to $0.00 Claim Price", "median_amount": 18.75, "10th_percentile": 18.75, "90th_percentile": 18.75, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $150.00 @ 12.5% = $18.75 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 97.5, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 97.5, "10th_percentile": 97.5, "90th_percentile": 97.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 90.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 90.0, "10th_percentile": 90.0, "90th_percentile": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 92.1, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 92.1, "10th_percentile": 92.1, "90th_percentile": 92.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 90.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 90.0, "10th_percentile": 90.0, "90th_percentile": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 83.85, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 83.85, "10th_percentile": 83.85, "90th_percentile": 83.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 87.66, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 87.66, "10th_percentile": 87.66, "90th_percentile": 87.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 81.75, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 81.75, "10th_percentile": 81.75, "90th_percentile": 81.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 81.75, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 81.75, "10th_percentile": 81.75, "90th_percentile": 81.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 81.75, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 81.75, "10th_percentile": 81.75, "90th_percentile": 81.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 63.0, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 63.0, "10th_percentile": 63.0, "90th_percentile": 63.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 63.0, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 63.0, "10th_percentile": 63.0, "90th_percentile": 63.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 92.1, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 92.1, "10th_percentile": 92.1, "90th_percentile": 92.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 75.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 100.35, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 100.35, "10th_percentile": 100.35, "90th_percentile": 100.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 130.5, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 130.5, "10th_percentile": 130.5, "90th_percentile": 130.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 120.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 120.0, "10th_percentile": 120.0, "90th_percentile": 120.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 87.66, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 87.66, "10th_percentile": 87.66, "90th_percentile": 87.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 94.5, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 94.5, "10th_percentile": 94.5, "90th_percentile": 94.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 70.5, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 70.5, "10th_percentile": 70.5, "90th_percentile": 70.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 81.53, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 81.53, "10th_percentile": 81.53, "90th_percentile": 81.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 90.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 90.0, "10th_percentile": 90.0, "90th_percentile": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 90.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 90.0, "10th_percentile": 90.0, "90th_percentile": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 90.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 90.0, "10th_percentile": 90.0, "90th_percentile": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 150.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.0, "10th_percentile": 150.0, "90th_percentile": 150.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 150.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.0, "10th_percentile": 150.0, "90th_percentile": 150.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 150.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.0, "10th_percentile": 150.0, "90th_percentile": 150.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 150.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.0, "10th_percentile": 150.0, "90th_percentile": 150.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 150.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.0, "10th_percentile": 150.0, "90th_percentile": 150.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Beta Hcg, Quantitative", "code_information": [ { "code": "PX-30105098", "type": "CDM" }, { "code": "84702", "type": "CPT" }, { "code": "0301", "type": "RC" } ], "standard_charges": [ { "minimum": 89.04, "maximum": 212.0, "setting": "outpatient", "gross_charge": 212.0, "discounted_cash": 148.4, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_algorithm": "No contract line matched", "median_amount": 212.0, "10th_percentile": 212.0, "90th_percentile": 212.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH AETNA", "standard_charge_algorithm": "No contract line matched", "median_amount": 212.0, "10th_percentile": 212.0, "90th_percentile": 212.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_algorithm": "No contract line matched", "median_amount": 212.0, "10th_percentile": 212.0, "90th_percentile": 212.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $212.00 @ 12.5% = $26.50 due to $0.00 Claim Price", "median_amount": 26.5, "10th_percentile": 26.5, "90th_percentile": 26.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $212.00 @ 12.5% = $26.50 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $212.00 @ 12.5% = $26.50 due to $0.00 Claim Price", "median_amount": 26.5, "10th_percentile": 26.5, "90th_percentile": 26.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $212.00 @ 12.5% = $26.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $212.00 @ 12.5% = $26.50 due to $0.00 Claim Price", "median_amount": 26.5, "10th_percentile": 26.5, "90th_percentile": 26.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $212.00 @ 12.5% = $26.50 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 89.04, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 89.04, "10th_percentile": 89.04, "90th_percentile": 89.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 89.04, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 89.04, "10th_percentile": 89.04, "90th_percentile": 89.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 127.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 127.2, "10th_percentile": 127.2, "90th_percentile": 127.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 127.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 127.2, "10th_percentile": 127.2, "90th_percentile": 127.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 127.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 127.2, "10th_percentile": 127.2, "90th_percentile": 127.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 99.64, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 99.64, "10th_percentile": 99.64, "90th_percentile": 99.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 133.56, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 133.56, "10th_percentile": 133.56, "90th_percentile": 133.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 115.22, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 115.22, "10th_percentile": 115.22, "90th_percentile": 115.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 106.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 106.0, "10th_percentile": 106.0, "90th_percentile": 106.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 123.89, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 123.89, "10th_percentile": 123.89, "90th_percentile": 123.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 130.17, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 130.17, "10th_percentile": 130.17, "90th_percentile": 130.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 169.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 169.6, "10th_percentile": 169.6, "90th_percentile": 169.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 184.44, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 184.44, "10th_percentile": 184.44, "90th_percentile": 184.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 137.8, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 137.8, "10th_percentile": 137.8, "90th_percentile": 137.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 137.8, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 137.8, "10th_percentile": 137.8, "90th_percentile": 137.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 137.8, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 137.8, "10th_percentile": 137.8, "90th_percentile": 137.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 127.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 127.2, "10th_percentile": 127.2, "90th_percentile": 127.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 127.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 127.2, "10th_percentile": 127.2, "90th_percentile": 127.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 130.17, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 130.17, "10th_percentile": 130.17, "90th_percentile": 130.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 123.89, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 123.89, "10th_percentile": 123.89, "90th_percentile": 123.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 118.51, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 118.51, "10th_percentile": 118.51, "90th_percentile": 118.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 115.54, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 115.54, "10th_percentile": 115.54, "90th_percentile": 115.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 115.54, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 115.54, "10th_percentile": 115.54, "90th_percentile": 115.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 115.54, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 115.54, "10th_percentile": 115.54, "90th_percentile": 115.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 212.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 212.0, "10th_percentile": 212.0, "90th_percentile": 212.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 212.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 212.0, "10th_percentile": 212.0, "90th_percentile": 212.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 212.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 212.0, "10th_percentile": 212.0, "90th_percentile": 212.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 212.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 212.0, "10th_percentile": 212.0, "90th_percentile": 212.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 212.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 212.0, "10th_percentile": 212.0, "90th_percentile": 212.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Biliary Stent Removal W/ Endoscopy", "code_information": [ { "code": "PX-75009025", "type": "CDM" }, { "code": "47999", "type": "CPT" }, { "code": "0750", "type": "RC" } ], "standard_charges": [ { "minimum": 2490.18, "maximum": 5929.0, "setting": "outpatient", "gross_charge": 5929.0, "discounted_cash": 4150.3, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,929.00 @ 12.5% = $741.13 due to $0.00 Claim Price", "median_amount": 741.13, "10th_percentile": 741.13, "90th_percentile": 741.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,929.00 @ 12.5% = $741.13 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,929.00 @ 12.5% = $741.13 due to $0.00 Claim Price", "median_amount": 741.13, "10th_percentile": 741.13, "90th_percentile": 741.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,929.00 @ 12.5% = $741.13 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,929.00 @ 12.5% = $741.13 due to $0.00 Claim Price", "median_amount": 741.13, "10th_percentile": 741.13, "90th_percentile": 741.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,929.00 @ 12.5% = $741.13 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3557.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 3853.85, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 3853.85, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 3853.85, "10th_percentile": 3853.85, "90th_percentile": 3853.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3640.41, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3640.41, "10th_percentile": 3640.41, "90th_percentile": 3640.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 3557.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3557.4, "10th_percentile": 3557.4, "90th_percentile": 3557.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3314.31, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 3314.31, "10th_percentile": 3314.31, "90th_percentile": 3314.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3464.91, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3464.91, "10th_percentile": 3464.91, "90th_percentile": 3464.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 3231.31, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3231.31, "10th_percentile": 3231.31, "90th_percentile": 3231.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 3231.31, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3231.31, "10th_percentile": 3231.31, "90th_percentile": 3231.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3231.31, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3231.31, "10th_percentile": 3231.31, "90th_percentile": 3231.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2490.18, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2490.18, "10th_percentile": 2490.18, "90th_percentile": 2490.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2490.18, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2490.18, "10th_percentile": 2490.18, "90th_percentile": 2490.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 3569.26, "standard_charge_percentage": 60.2, "standard_charge_algorithm": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3569.26, "10th_percentile": 3569.26, "90th_percentile": 3569.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 3978.36, "standard_charge_percentage": 67.1, "standard_charge_algorithm": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3978.36, "10th_percentile": 3978.36, "90th_percentile": 3978.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 3853.85, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 3853.85, "10th_percentile": 3853.85, "90th_percentile": 3853.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3640.41, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3640.41, "10th_percentile": 3640.41, "90th_percentile": 3640.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2964.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2964.5, "10th_percentile": 2964.5, "90th_percentile": 2964.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 3966.5, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3966.5, "10th_percentile": 3966.5, "90th_percentile": 3966.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 5158.23, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 5158.23, "10th_percentile": 5158.23, "90th_percentile": 5158.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 4743.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 4743.2, "10th_percentile": 4743.2, "90th_percentile": 4743.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3464.91, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3464.91, "10th_percentile": 3464.91, "90th_percentile": 3464.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 3735.27, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 3735.27, "10th_percentile": 3735.27, "90th_percentile": 3735.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2786.63, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2786.63, "10th_percentile": 2786.63, "90th_percentile": 2786.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 3222.41, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 3222.41, "10th_percentile": 3222.41, "90th_percentile": 3222.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3557.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 3557.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3557.4, "10th_percentile": 3557.4, "90th_percentile": 3557.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 3557.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3557.4, "10th_percentile": 3557.4, "90th_percentile": 3557.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5929.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5929.0, "10th_percentile": 5929.0, "90th_percentile": 5929.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5929.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5929.0, "10th_percentile": 5929.0, "90th_percentile": 5929.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5929.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5929.0, "10th_percentile": 5929.0, "90th_percentile": 5929.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5929.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5929.0, "10th_percentile": 5929.0, "90th_percentile": 5929.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5929.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5929.0, "10th_percentile": 5929.0, "90th_percentile": 5929.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Biopsy Abdominal Wall Mass - Unlisted", "code_information": [ { "code": "PX-76100808", "type": "CDM" }, { "code": "22999", "type": "CPT" }, { "code": "0361", "type": "RC" } ], "standard_charges": [ { "minimum": 2718.63, "maximum": 3030.24, "setting": "outpatient", "gross_charge": 4516.0, "discounted_cash": 3161.2, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 2718.63, "standard_charge_percentage": 60.2, "standard_charge_algorithm": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2718.63, "10th_percentile": 2718.63, "90th_percentile": 2718.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 3030.24, "standard_charge_percentage": 67.1, "standard_charge_algorithm": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3030.24, "10th_percentile": 3030.24, "90th_percentile": 3030.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "HB Biopsy Nail Unit", "code_information": [ { "code": "PX-36100068", "type": "CDM" }, { "code": "11755", "type": "CPT" }, { "code": "0361", "type": "RC" } ], "standard_charges": [ { "minimum": 1860.18, "maximum": 2073.39, "setting": "outpatient", "gross_charge": 3090.0, "discounted_cash": 2163.0, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1860.18, "standard_charge_percentage": 60.2, "standard_charge_algorithm": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1860.18, "10th_percentile": 1860.18, "90th_percentile": 1860.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 2073.39, "standard_charge_percentage": 67.1, "standard_charge_algorithm": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2073.39, "10th_percentile": 2073.39, "90th_percentile": 2073.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "HB Biopsy Penis Separate Procedure", "code_information": [ { "code": "PX-76100587", "type": "CDM" }, { "code": "54100", "type": "CPT" }, { "code": "0361", "type": "RC" } ], "standard_charges": [ { "minimum": 4285.04, "maximum": 4776.18, "setting": "outpatient", "gross_charge": 7118.0, "discounted_cash": 4982.6, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 4285.04, "standard_charge_percentage": 60.2, "standard_charge_algorithm": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4285.04, "10th_percentile": 4285.04, "90th_percentile": 4285.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 4776.18, "standard_charge_percentage": 67.1, "standard_charge_algorithm": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4776.18, "10th_percentile": 4776.18, "90th_percentile": 4776.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "HB Biopsy of Cervix", "code_information": [ { "code": "PX-36100659", "type": "CDM" }, { "code": "57500", "type": "CPT" }, { "code": "0361", "type": "RC" } ], "standard_charges": [ { "minimum": 3062.98, "maximum": 3414.05, "setting": "outpatient", "gross_charge": 5088.0, "discounted_cash": 3561.6, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 3062.98, "standard_charge_percentage": 60.2, "standard_charge_algorithm": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3062.98, "10th_percentile": 3062.98, "90th_percentile": 3062.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 3414.05, "standard_charge_percentage": 67.1, "standard_charge_algorithm": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3414.05, "10th_percentile": 3414.05, "90th_percentile": 3414.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "HB Biopsy of Cervix", "code_information": [ { "code": "PX-36100659", "type": "CDM" }, { "code": "57500", "type": "CPT" }, { "code": "0761", "type": "RC" } ], "standard_charges": [ { "minimum": 2136.96, "maximum": 5088.0, "setting": "outpatient", "gross_charge": 5088.0, "discounted_cash": 3561.6, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,088.00 @ 12.5% = $636.00 due to $0.00 Claim Price", "median_amount": 636.0, "10th_percentile": 636.0, "90th_percentile": 636.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,088.00 @ 12.5% = $636.00 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,088.00 @ 12.5% = $636.00 due to $0.00 Claim Price", "median_amount": 636.0, "10th_percentile": 636.0, "90th_percentile": 636.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,088.00 @ 12.5% = $636.00 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,088.00 @ 12.5% = $636.00 due to $0.00 Claim Price", "median_amount": 636.0, "10th_percentile": 636.0, "90th_percentile": 636.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,088.00 @ 12.5% = $636.00 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3052.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 3307.2, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3124.03, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3124.03, "10th_percentile": 3124.03, "90th_percentile": 3124.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 3052.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3052.8, "10th_percentile": 3052.8, "90th_percentile": 3052.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2844.19, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2844.19, "10th_percentile": 2844.19, "90th_percentile": 2844.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2973.43, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2973.43, "10th_percentile": 2973.43, "90th_percentile": 2973.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2772.96, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2772.96, "10th_percentile": 2772.96, "90th_percentile": 2772.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2772.96, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2772.96, "10th_percentile": 2772.96, "90th_percentile": 2772.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2772.96, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2772.96, "10th_percentile": 2772.96, "90th_percentile": 2772.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2136.96, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2136.96, "10th_percentile": 2136.96, "90th_percentile": 2136.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2136.96, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2136.96, "10th_percentile": 2136.96, "90th_percentile": 2136.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3124.03, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3124.03, "10th_percentile": 3124.03, "90th_percentile": 3124.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 4070.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 4070.4, "10th_percentile": 4070.4, "90th_percentile": 4070.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 3403.87, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3403.87, "10th_percentile": 3403.87, "90th_percentile": 3403.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 4426.56, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 4426.56, "10th_percentile": 4426.56, "90th_percentile": 4426.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2973.43, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2973.43, "10th_percentile": 2973.43, "90th_percentile": 2973.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH THE ALLIANCE", "standard_charge_dollar": 2765.33, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2765.33, "10th_percentile": 2765.33, "90th_percentile": 2765.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 3205.44, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 3205.44, "10th_percentile": 3205.44, "90th_percentile": 3205.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2391.36, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2391.36, "10th_percentile": 2391.36, "90th_percentile": 2391.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2544.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2544.0, "10th_percentile": 2544.0, "90th_percentile": 2544.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH DREYER - IPA", "standard_charge_dollar": 3052.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3052.8, "10th_percentile": 3052.8, "90th_percentile": 3052.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 3052.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3052.8, "10th_percentile": 3052.8, "90th_percentile": 3052.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3052.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5088.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5088.0, "10th_percentile": 5088.0, "90th_percentile": 5088.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5088.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5088.0, "10th_percentile": 5088.0, "90th_percentile": 5088.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5088.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5088.0, "10th_percentile": 5088.0, "90th_percentile": 5088.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5088.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5088.0, "10th_percentile": 5088.0, "90th_percentile": 5088.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5088.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5088.0, "10th_percentile": 5088.0, "90th_percentile": 5088.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Biopsy/Removal Lymph Nodes Open Superficial", "code_information": [ { "code": "PX-36100529", "type": "CDM" }, { "code": "38500", "type": "CPT" }, { "code": "0361", "type": "RC" } ], "standard_charges": [ { "minimum": 5870.7, "maximum": 6543.59, "setting": "outpatient", "gross_charge": 9752.0, "discounted_cash": 6826.4, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 5870.7, "standard_charge_percentage": 60.2, "standard_charge_algorithm": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5870.7, "10th_percentile": 5870.7, "90th_percentile": 5870.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 6543.59, "standard_charge_percentage": 67.1, "standard_charge_algorithm": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6543.59, "10th_percentile": 6543.59, "90th_percentile": 6543.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "HB Biopsy/Removal Lymph Nodes Open Superficial", "code_information": [ { "code": "PX-36100529", "type": "CDM" }, { "code": "38500", "type": "CPT" }, { "code": "0761", "type": "RC" } ], "standard_charges": [ { "minimum": 4095.84, "maximum": 9752.0, "setting": "outpatient", "gross_charge": 9752.0, "discounted_cash": 6826.4, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 9752.0, "10th_percentile": 9752.0, "90th_percentile": 9752.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 9752.0, "10th_percentile": 9752.0, "90th_percentile": 9752.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 9752.0, "10th_percentile": 9752.0, "90th_percentile": 9752.0, "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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 5851.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 6338.8, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 5851.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 5851.2, "10th_percentile": 5851.2, "90th_percentile": 5851.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 5451.37, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 5451.37, "10th_percentile": 5451.37, "90th_percentile": 5451.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 5699.07, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5699.07, "10th_percentile": 5699.07, "90th_percentile": 5699.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 4095.84, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 4095.84, "10th_percentile": 4095.84, "90th_percentile": 4095.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 4095.84, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 4095.84, "10th_percentile": 4095.84, "90th_percentile": 4095.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 7801.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 7801.6, "10th_percentile": 7801.6, "90th_percentile": 7801.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 6524.09, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6524.09, "10th_percentile": 6524.09, "90th_percentile": 6524.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 8484.24, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 8484.24, "10th_percentile": 8484.24, "90th_percentile": 8484.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 5699.07, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5699.07, "10th_percentile": 5699.07, "90th_percentile": 5699.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH THE ALLIANCE", "standard_charge_dollar": 5300.21, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 5300.21, "10th_percentile": 5300.21, "90th_percentile": 5300.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 6143.76, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 6143.76, "10th_percentile": 6143.76, "90th_percentile": 6143.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 4583.44, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 4583.44, "10th_percentile": 4583.44, "90th_percentile": 4583.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 4876.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 4876.0, "10th_percentile": 4876.0, "90th_percentile": 4876.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH DREYER - IPA", "standard_charge_dollar": 5851.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 5851.2, "10th_percentile": 5851.2, "90th_percentile": 5851.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 5851.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5851.2, "10th_percentile": 5851.2, "90th_percentile": 5851.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 5851.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9752.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9752.0, "10th_percentile": 9752.0, "90th_percentile": 9752.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9752.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9752.0, "10th_percentile": 9752.0, "90th_percentile": 9752.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9752.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9752.0, "10th_percentile": 9752.0, "90th_percentile": 9752.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9752.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9752.0, "10th_percentile": 9752.0, "90th_percentile": 9752.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9752.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9752.0, "10th_percentile": 9752.0, "90th_percentile": 9752.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Blood Gases (Ph, Pco2, Po2, Co2,Hco3) Epoc (POCT)", "code_information": [ { "code": "PX-30001263", "type": "CDM" }, { "code": "82803", "type": "CPT" }, { "code": "0301", "type": "RC" } ], "standard_charges": [ { "minimum": 128.1, "maximum": 305.0, "setting": "outpatient", "gross_charge": 305.0, "discounted_cash": 213.5, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $305.00 @ 12.5% = $38.13 due to $0.00 Claim Price", "median_amount": 38.13, "10th_percentile": 38.13, "90th_percentile": 38.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $305.00 @ 12.5% = $38.13 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $305.00 @ 12.5% = $38.13 due to $0.00 Claim Price", "median_amount": 38.13, "10th_percentile": 38.13, "90th_percentile": 38.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $305.00 @ 12.5% = $38.13 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $305.00 @ 12.5% = $38.13 due to $0.00 Claim Price", "median_amount": 38.13, "10th_percentile": 38.13, "90th_percentile": 38.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $305.00 @ 12.5% = $38.13 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 128.1, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 128.1, "10th_percentile": 128.1, "90th_percentile": 128.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 128.1, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 128.1, "10th_percentile": 128.1, "90th_percentile": 128.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 183.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 183.0, "10th_percentile": 183.0, "90th_percentile": 183.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 183.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 183.0, "10th_percentile": 183.0, "90th_percentile": 183.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 183.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 183.0, "10th_percentile": 183.0, "90th_percentile": 183.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 143.35, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 143.35, "10th_percentile": 143.35, "90th_percentile": 143.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 192.15, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 192.15, "10th_percentile": 192.15, "90th_percentile": 192.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 165.77, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 165.77, "10th_percentile": 165.77, "90th_percentile": 165.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 152.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 152.5, "10th_percentile": 152.5, "90th_percentile": 152.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 178.24, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 178.24, "10th_percentile": 178.24, "90th_percentile": 178.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 187.27, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 187.27, "10th_percentile": 187.27, "90th_percentile": 187.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 244.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 244.0, "10th_percentile": 244.0, "90th_percentile": 244.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 265.35, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 265.35, "10th_percentile": 265.35, "90th_percentile": 265.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 198.25, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 198.25, "10th_percentile": 198.25, "90th_percentile": 198.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 204.05, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 204.05, "10th_percentile": 204.05, "90th_percentile": 204.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 198.25, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 198.25, "10th_percentile": 198.25, "90th_percentile": 198.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 198.25, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 198.25, "10th_percentile": 198.25, "90th_percentile": 198.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 183.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 183.0, "10th_percentile": 183.0, "90th_percentile": 183.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 183.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 183.0, "10th_percentile": 183.0, "90th_percentile": 183.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 187.27, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 187.27, "10th_percentile": 187.27, "90th_percentile": 187.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 178.24, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 178.24, "10th_percentile": 178.24, "90th_percentile": 178.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 170.5, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 170.5, "10th_percentile": 170.5, "90th_percentile": 170.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 166.23, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 166.23, "10th_percentile": 166.23, "90th_percentile": 166.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 166.23, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 166.23, "10th_percentile": 166.23, "90th_percentile": 166.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 166.23, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 166.23, "10th_percentile": 166.23, "90th_percentile": 166.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 305.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 305.0, "10th_percentile": 305.0, "90th_percentile": 305.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 305.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 305.0, "10th_percentile": 305.0, "90th_percentile": 305.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 305.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 305.0, "10th_percentile": 305.0, "90th_percentile": 305.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 305.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 305.0, "10th_percentile": 305.0, "90th_percentile": 305.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 305.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 305.0, "10th_percentile": 305.0, "90th_percentile": 305.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Brachytx Isodose Intermed", "code_information": [ { "code": "PX-33300017", "type": "CDM" }, { "code": "77317", "type": "CPT" }, { "code": "0333", "type": "RC" } ], "standard_charges": [ { "minimum": 2442.72, "maximum": 5816.0, "setting": "outpatient", "gross_charge": 5816.0, "discounted_cash": 4071.2, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_algorithm": "No contract line matched", "median_amount": 5816.0, "10th_percentile": 5816.0, "90th_percentile": 5816.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 5816.0, "10th_percentile": 5816.0, "90th_percentile": 5816.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,816.00 @ 12.5% = $727.00 due to $0.00 Claim Price", "median_amount": 727.0, "10th_percentile": 727.0, "90th_percentile": 727.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,816.00 @ 12.5% = $727.00 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,816.00 @ 12.5% = $727.00 due to $0.00 Claim Price", "median_amount": 727.0, "10th_percentile": 727.0, "90th_percentile": 727.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,816.00 @ 12.5% = $727.00 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,816.00 @ 12.5% = $727.00 due to $0.00 Claim Price", "median_amount": 727.0, "10th_percentile": 727.0, "90th_percentile": 727.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,816.00 @ 12.5% = $727.00 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3489.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 3780.4, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3571.02, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3571.02, "10th_percentile": 3571.02, "90th_percentile": 3571.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 3489.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3489.6, "10th_percentile": 3489.6, "90th_percentile": 3489.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3251.14, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 3251.14, "10th_percentile": 3251.14, "90th_percentile": 3251.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3398.87, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3398.87, "10th_percentile": 3398.87, "90th_percentile": 3398.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 3169.72, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3169.72, "10th_percentile": 3169.72, "90th_percentile": 3169.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 3169.72, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3169.72, "10th_percentile": 3169.72, "90th_percentile": 3169.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3169.72, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3169.72, "10th_percentile": 3169.72, "90th_percentile": 3169.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2442.72, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2442.72, "10th_percentile": 2442.72, "90th_percentile": 2442.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2442.72, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2442.72, "10th_percentile": 2442.72, "90th_percentile": 2442.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3571.02, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3571.02, "10th_percentile": 3571.02, "90th_percentile": 3571.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2908.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2908.0, "10th_percentile": 2908.0, "90th_percentile": 2908.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 3890.9, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3890.9, "10th_percentile": 3890.9, "90th_percentile": 3890.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 5059.92, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 5059.92, "10th_percentile": 5059.92, "90th_percentile": 5059.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 4652.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 4652.8, "10th_percentile": 4652.8, "90th_percentile": 4652.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3398.87, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3398.87, "10th_percentile": 3398.87, "90th_percentile": 3398.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 3664.08, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 3664.08, "10th_percentile": 3664.08, "90th_percentile": 3664.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2733.52, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2733.52, "10th_percentile": 2733.52, "90th_percentile": 2733.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 3161.0, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 3161.0, "10th_percentile": 3161.0, "90th_percentile": 3161.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3489.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 3489.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3489.6, "10th_percentile": 3489.6, "90th_percentile": 3489.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 3489.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3489.6, "10th_percentile": 3489.6, "90th_percentile": 3489.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5816.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5816.0, "10th_percentile": 5816.0, "90th_percentile": 5816.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5816.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5816.0, "10th_percentile": 5816.0, "90th_percentile": 5816.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5816.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5816.0, "10th_percentile": 5816.0, "90th_percentile": 5816.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5816.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5816.0, "10th_percentile": 5816.0, "90th_percentile": 5816.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5816.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5816.0, "10th_percentile": 5816.0, "90th_percentile": 5816.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Breast Tomosynthesis Bilat", "code_information": [ { "code": "PX-40100004", "type": "CDM" }, { "code": "77062", "type": "CPT" }, { "code": "0401", "type": "RC" } ], "standard_charges": [ { "minimum": 67.62, "maximum": 161.0, "setting": "outpatient", "gross_charge": 161.0, "discounted_cash": 112.7, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_algorithm": "No contract line matched", "median_amount": 161.0, "10th_percentile": 161.0, "90th_percentile": 161.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 161.0, "10th_percentile": 161.0, "90th_percentile": 161.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $161.00 @ 12.5% = $20.13 due to $0.00 Claim Price", "median_amount": 20.13, "10th_percentile": 20.13, "90th_percentile": 20.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $161.00 @ 12.5% = $20.13 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $161.00 @ 12.5% = $20.13 due to $0.00 Claim Price", "median_amount": 20.13, "10th_percentile": 20.13, "90th_percentile": 20.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $161.00 @ 12.5% = $20.13 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $161.00 @ 12.5% = $20.13 due to $0.00 Claim Price", "median_amount": 20.13, "10th_percentile": 20.13, "90th_percentile": 20.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $161.00 @ 12.5% = $20.13 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 104.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 104.65, "10th_percentile": 104.65, "90th_percentile": 104.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 96.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 96.6, "10th_percentile": 96.6, "90th_percentile": 96.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 104.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 104.65, "10th_percentile": 104.65, "90th_percentile": 104.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 98.85, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 98.85, "10th_percentile": 98.85, "90th_percentile": 98.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 96.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 96.6, "10th_percentile": 96.6, "90th_percentile": 96.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 90.0, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 90.0, "10th_percentile": 90.0, "90th_percentile": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 94.09, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 94.09, "10th_percentile": 94.09, "90th_percentile": 94.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 87.75, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 87.75, "10th_percentile": 87.75, "90th_percentile": 87.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 87.75, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 87.75, "10th_percentile": 87.75, "90th_percentile": 87.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 87.75, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 87.75, "10th_percentile": 87.75, "90th_percentile": 87.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 67.62, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 67.62, "10th_percentile": 67.62, "90th_percentile": 67.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 67.62, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 67.62, "10th_percentile": 67.62, "90th_percentile": 67.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 104.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 104.65, "10th_percentile": 104.65, "90th_percentile": 104.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 98.85, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 98.85, "10th_percentile": 98.85, "90th_percentile": 98.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 80.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 80.5, "10th_percentile": 80.5, "90th_percentile": 80.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 107.71, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 107.71, "10th_percentile": 107.71, "90th_percentile": 107.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 140.07, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 140.07, "10th_percentile": 140.07, "90th_percentile": 140.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 128.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 128.8, "10th_percentile": 128.8, "90th_percentile": 128.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 94.09, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 94.09, "10th_percentile": 94.09, "90th_percentile": 94.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 101.43, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 101.43, "10th_percentile": 101.43, "90th_percentile": 101.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 75.67, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 75.67, "10th_percentile": 75.67, "90th_percentile": 75.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 87.5, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 87.5, "10th_percentile": 87.5, "90th_percentile": 87.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 96.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 96.6, "10th_percentile": 96.6, "90th_percentile": 96.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 96.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.6, "10th_percentile": 96.6, "90th_percentile": 96.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 96.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 96.6, "10th_percentile": 96.6, "90th_percentile": 96.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 161.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 161.0, "10th_percentile": 161.0, "90th_percentile": 161.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 161.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 161.0, "10th_percentile": 161.0, "90th_percentile": 161.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 161.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 161.0, "10th_percentile": 161.0, "90th_percentile": 161.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 161.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 161.0, "10th_percentile": 161.0, "90th_percentile": 161.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 161.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 161.0, "10th_percentile": 161.0, "90th_percentile": 161.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Btw-Work Hard Ea Addl Hour", "code_information": [ { "code": "PX-42000044", "type": "CDM" }, { "code": "97546", "type": "CPT" }, { "code": "0420", "type": "RC" } ], "standard_charges": [ { "minimum": 65.94, "maximum": 157.0, "setting": "outpatient", "gross_charge": 157.0, "discounted_cash": 109.9, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 12.5% = $19.63 due to $0.00 Claim Price", "median_amount": 19.63, "10th_percentile": 19.63, "90th_percentile": 19.63, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 12.5% = $19.63 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 12.5% = $19.63 due to $0.00 Claim Price", "median_amount": 19.63, "10th_percentile": 19.63, "90th_percentile": 19.63, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 12.5% = $19.63 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 12.5% = $19.63 due to $0.00 Claim Price", "median_amount": 19.63, "10th_percentile": 19.63, "90th_percentile": 19.63, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 12.5% = $19.63 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 102.05, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 102.05, "10th_percentile": 102.05, "90th_percentile": 102.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 94.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 94.2, "10th_percentile": 94.2, "90th_percentile": 94.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 102.05, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 102.05, "10th_percentile": 102.05, "90th_percentile": 102.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 96.4, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 96.4, "10th_percentile": 96.4, "90th_percentile": 96.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 94.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 94.2, "10th_percentile": 94.2, "90th_percentile": 94.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 87.76, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 87.76, "10th_percentile": 87.76, "90th_percentile": 87.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 91.75, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 91.75, "10th_percentile": 91.75, "90th_percentile": 91.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 85.57, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 85.57, "10th_percentile": 85.57, "90th_percentile": 85.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 85.57, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 85.57, "10th_percentile": 85.57, "90th_percentile": 85.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 85.57, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 85.57, "10th_percentile": 85.57, "90th_percentile": 85.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 65.94, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 65.94, "10th_percentile": 65.94, "90th_percentile": 65.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 65.94, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 65.94, "10th_percentile": 65.94, "90th_percentile": 65.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 102.05, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 102.05, "10th_percentile": 102.05, "90th_percentile": 102.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 96.4, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 96.4, "10th_percentile": 96.4, "90th_percentile": 96.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 105.03, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 105.03, "10th_percentile": 105.03, "90th_percentile": 105.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 136.59, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 136.59, "10th_percentile": 136.59, "90th_percentile": 136.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 125.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 125.6, "10th_percentile": 125.6, "90th_percentile": 125.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 91.75, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 91.75, "10th_percentile": 91.75, "90th_percentile": 91.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 98.91, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 98.91, "10th_percentile": 98.91, "90th_percentile": 98.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 73.79, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 73.79, "10th_percentile": 73.79, "90th_percentile": 73.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 85.33, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 85.33, "10th_percentile": 85.33, "90th_percentile": 85.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 94.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 94.2, "10th_percentile": 94.2, "90th_percentile": 94.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 94.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 94.2, "10th_percentile": 94.2, "90th_percentile": 94.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 157.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 157.0, "10th_percentile": 157.0, "90th_percentile": 157.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 157.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 157.0, "10th_percentile": 157.0, "90th_percentile": 157.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 157.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 157.0, "10th_percentile": 157.0, "90th_percentile": 157.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 157.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 157.0, "10th_percentile": 157.0, "90th_percentile": 157.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 157.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 157.0, "10th_percentile": 157.0, "90th_percentile": 157.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB C-Peptide", "code_information": [ { "code": "PX-30105203", "type": "CDM" }, { "code": "84681", "type": "CPT" }, { "code": "0301", "type": "RC" } ], "standard_charges": [ { "minimum": 62.16, "maximum": 148.0, "setting": "outpatient", "gross_charge": 148.0, "discounted_cash": 103.6, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $148.00 @ 12.5% = $18.50 due to $0.00 Claim Price", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $148.00 @ 12.5% = $18.50 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $148.00 @ 12.5% = $18.50 due to $0.00 Claim Price", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $148.00 @ 12.5% = $18.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $148.00 @ 12.5% = $18.50 due to $0.00 Claim Price", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $148.00 @ 12.5% = $18.50 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 62.16, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 62.16, "10th_percentile": 62.16, "90th_percentile": 62.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 62.16, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 62.16, "10th_percentile": 62.16, "90th_percentile": 62.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 88.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 88.8, "10th_percentile": 88.8, "90th_percentile": 88.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 88.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 88.8, "10th_percentile": 88.8, "90th_percentile": 88.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 88.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 88.8, "10th_percentile": 88.8, "90th_percentile": 88.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 69.56, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 69.56, "10th_percentile": 69.56, "90th_percentile": 69.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 93.24, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 93.24, "10th_percentile": 93.24, "90th_percentile": 93.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 80.44, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 80.44, "10th_percentile": 80.44, "90th_percentile": 80.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 74.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 74.0, "10th_percentile": 74.0, "90th_percentile": 74.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 86.49, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 86.49, "10th_percentile": 86.49, "90th_percentile": 86.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 90.87, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 90.87, "10th_percentile": 90.87, "90th_percentile": 90.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 118.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 118.4, "10th_percentile": 118.4, "90th_percentile": 118.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 128.76, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 128.76, "10th_percentile": 128.76, "90th_percentile": 128.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 96.2, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 96.2, "10th_percentile": 96.2, "90th_percentile": 96.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 99.01, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 99.01, "10th_percentile": 99.01, "90th_percentile": 99.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 96.2, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 96.2, "10th_percentile": 96.2, "90th_percentile": 96.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 96.2, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 96.2, "10th_percentile": 96.2, "90th_percentile": 96.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 88.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 88.8, "10th_percentile": 88.8, "90th_percentile": 88.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 88.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 88.8, "10th_percentile": 88.8, "90th_percentile": 88.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 90.87, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 90.87, "10th_percentile": 90.87, "90th_percentile": 90.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 86.49, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 86.49, "10th_percentile": 86.49, "90th_percentile": 86.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 82.73, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 82.73, "10th_percentile": 82.73, "90th_percentile": 82.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 80.66, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 80.66, "10th_percentile": 80.66, "90th_percentile": 80.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 80.66, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 80.66, "10th_percentile": 80.66, "90th_percentile": 80.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 80.66, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 80.66, "10th_percentile": 80.66, "90th_percentile": 80.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 148.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 148.0, "10th_percentile": 148.0, "90th_percentile": 148.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 148.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 148.0, "10th_percentile": 148.0, "90th_percentile": 148.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 148.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 148.0, "10th_percentile": 148.0, "90th_percentile": 148.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 148.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 148.0, "10th_percentile": 148.0, "90th_percentile": 148.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 148.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 148.0, "10th_percentile": 148.0, "90th_percentile": 148.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB CT Angio Abd&Pelv W/O&W/Dye", "code_information": [ { "code": "PX-35200032", "type": "CDM" }, { "code": "74174", "type": "CPT" }, { "code": "0352", "type": "RC" } ], "standard_charges": [ { "minimum": 3252.06, "maximum": 7743.0, "setting": "outpatient", "gross_charge": 7743.0, "discounted_cash": 5420.1, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 3639.21, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 3825.04, "10th_percentile": 3825.04, "90th_percentile": 3825.04, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,743.00 @ 12.5% = $967.88 due to $0.00 Claim Price", "median_amount": 967.88, "10th_percentile": 967.88, "90th_percentile": 967.88, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,743.00 @ 12.5% = $967.88 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,743.00 @ 12.5% = $967.88 due to $0.00 Claim Price", "median_amount": 967.88, "10th_percentile": 967.88, "90th_percentile": 967.88, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,743.00 @ 12.5% = $967.88 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,743.00 @ 12.5% = $967.88 due to $0.00 Claim Price", "median_amount": 967.88, "10th_percentile": 967.88, "90th_percentile": 967.88, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,743.00 @ 12.5% = $967.88 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 4645.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 5032.95, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 4754.2, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 4754.2, "10th_percentile": 4754.2, "90th_percentile": 4754.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 4645.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 4645.8, "10th_percentile": 4645.8, "90th_percentile": 4645.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 4328.34, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 4328.34, "10th_percentile": 4328.34, "90th_percentile": 4328.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 4525.01, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4525.01, "10th_percentile": 4525.01, "90th_percentile": 4525.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 4219.94, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 4219.94, "10th_percentile": 4219.94, "90th_percentile": 4219.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 4219.94, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 4219.94, "10th_percentile": 4219.94, "90th_percentile": 4219.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 4219.94, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 4219.94, "10th_percentile": 4219.94, "90th_percentile": 4219.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 3252.06, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 3252.06, "10th_percentile": 3252.06, "90th_percentile": 3252.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 3252.06, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 3252.06, "10th_percentile": 3252.06, "90th_percentile": 3252.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 4754.2, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 4754.2, "10th_percentile": 4754.2, "90th_percentile": 4754.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 3871.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 3871.5, "10th_percentile": 3871.5, "90th_percentile": 3871.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 5180.07, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5180.07, "10th_percentile": 5180.07, "90th_percentile": 5180.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 6736.41, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 6736.41, "10th_percentile": 6736.41, "90th_percentile": 6736.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 6194.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 6194.4, "10th_percentile": 6194.4, "90th_percentile": 6194.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 4525.01, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4525.01, "10th_percentile": 4525.01, "90th_percentile": 4525.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 4878.09, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 4878.09, "10th_percentile": 4878.09, "90th_percentile": 4878.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 4208.32, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 4208.32, "10th_percentile": 4208.32, "90th_percentile": 4208.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 4645.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 4645.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4645.8, "10th_percentile": 4645.8, "90th_percentile": 4645.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 4645.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 4645.8, "10th_percentile": 4645.8, "90th_percentile": 4645.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7743.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7743.0, "10th_percentile": 7743.0, "90th_percentile": 7743.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7743.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7743.0, "10th_percentile": 7743.0, "90th_percentile": 7743.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7743.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7743.0, "10th_percentile": 7743.0, "90th_percentile": 7743.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7743.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7743.0, "10th_percentile": 7743.0, "90th_percentile": 7743.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7743.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7743.0, "10th_percentile": 7743.0, "90th_percentile": 7743.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB CT Angio Abdominal Arteries", "code_information": [ { "code": "PX-35200038", "type": "CDM" }, { "code": "75635", "type": "CPT" }, { "code": "0352", "type": "RC" } ], "standard_charges": [ { "minimum": 2333.94, "maximum": 5557.0, "setting": "outpatient", "gross_charge": 5557.0, "discounted_cash": 3889.9, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,557.00 @ 12.5% = $694.63 due to $0.00 Claim Price", "median_amount": 694.63, "10th_percentile": 694.63, "90th_percentile": 694.63, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,557.00 @ 12.5% = $694.63 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,557.00 @ 12.5% = $694.63 due to $0.00 Claim Price", "median_amount": 694.63, "10th_percentile": 694.63, "90th_percentile": 694.63, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,557.00 @ 12.5% = $694.63 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,557.00 @ 12.5% = $694.63 due to $0.00 Claim Price", "median_amount": 694.63, "10th_percentile": 694.63, "90th_percentile": 694.63, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,557.00 @ 12.5% = $694.63 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3334.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 3612.05, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3412.0, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3412.0, "10th_percentile": 3412.0, "90th_percentile": 3412.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 3334.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3334.2, "10th_percentile": 3334.2, "90th_percentile": 3334.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3106.36, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 3106.36, "10th_percentile": 3106.36, "90th_percentile": 3106.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3247.51, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3247.51, "10th_percentile": 3247.51, "90th_percentile": 3247.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 3028.57, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3028.57, "10th_percentile": 3028.57, "90th_percentile": 3028.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 3028.57, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3028.57, "10th_percentile": 3028.57, "90th_percentile": 3028.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3028.57, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3028.57, "10th_percentile": 3028.57, "90th_percentile": 3028.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2333.94, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2333.94, "10th_percentile": 2333.94, "90th_percentile": 2333.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2333.94, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2333.94, "10th_percentile": 2333.94, "90th_percentile": 2333.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3412.0, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3412.0, "10th_percentile": 3412.0, "90th_percentile": 3412.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2778.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2778.5, "10th_percentile": 2778.5, "90th_percentile": 2778.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 3717.63, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3717.63, "10th_percentile": 3717.63, "90th_percentile": 3717.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 4834.59, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 4834.59, "10th_percentile": 4834.59, "90th_percentile": 4834.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 4445.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 4445.6, "10th_percentile": 4445.6, "90th_percentile": 4445.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3247.51, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3247.51, "10th_percentile": 3247.51, "90th_percentile": 3247.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 3500.91, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 3500.91, "10th_percentile": 3500.91, "90th_percentile": 3500.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2611.79, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2611.79, "10th_percentile": 2611.79, "90th_percentile": 2611.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 3020.23, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 3020.23, "10th_percentile": 3020.23, "90th_percentile": 3020.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3334.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 3334.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3334.2, "10th_percentile": 3334.2, "90th_percentile": 3334.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 3334.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3334.2, "10th_percentile": 3334.2, "90th_percentile": 3334.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5557.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5557.0, "10th_percentile": 5557.0, "90th_percentile": 5557.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5557.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5557.0, "10th_percentile": 5557.0, "90th_percentile": 5557.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5557.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5557.0, "10th_percentile": 5557.0, "90th_percentile": 5557.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5557.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5557.0, "10th_percentile": 5557.0, "90th_percentile": 5557.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5557.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5557.0, "10th_percentile": 5557.0, "90th_percentile": 5557.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB CT Angio Upr Extrm W/O&W/Dye", "code_information": [ { "code": "PX-35200024", "type": "CDM" }, { "code": "73206", "type": "CPT" }, { "code": "0352", "type": "RC" } ], "standard_charges": [ { "minimum": 1815.66, "maximum": 4323.0, "setting": "outpatient", "gross_charge": 4323.0, "discounted_cash": 3026.1, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,323.00 @ 12.5% = $540.38 due to $0.00 Claim Price", "median_amount": 540.38, "10th_percentile": 540.38, "90th_percentile": 540.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,323.00 @ 12.5% = $540.38 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,323.00 @ 12.5% = $540.38 due to $0.00 Claim Price", "median_amount": 540.38, "10th_percentile": 540.38, "90th_percentile": 540.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,323.00 @ 12.5% = $540.38 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,323.00 @ 12.5% = $540.38 due to $0.00 Claim Price", "median_amount": 540.38, "10th_percentile": 540.38, "90th_percentile": 540.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,323.00 @ 12.5% = $540.38 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2593.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2809.95, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2654.32, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 2654.32, "10th_percentile": 2654.32, "90th_percentile": 2654.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2593.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 2593.8, "10th_percentile": 2593.8, "90th_percentile": 2593.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2416.56, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2416.56, "10th_percentile": 2416.56, "90th_percentile": 2416.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2526.36, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2526.36, "10th_percentile": 2526.36, "90th_percentile": 2526.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2356.04, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2356.04, "10th_percentile": 2356.04, "90th_percentile": 2356.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2356.04, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2356.04, "10th_percentile": 2356.04, "90th_percentile": 2356.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2356.04, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2356.04, "10th_percentile": 2356.04, "90th_percentile": 2356.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1815.66, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1815.66, "10th_percentile": 1815.66, "90th_percentile": 1815.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1815.66, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1815.66, "10th_percentile": 1815.66, "90th_percentile": 1815.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2654.32, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 2654.32, "10th_percentile": 2654.32, "90th_percentile": 2654.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2161.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2161.5, "10th_percentile": 2161.5, "90th_percentile": 2161.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2892.09, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2892.09, "10th_percentile": 2892.09, "90th_percentile": 2892.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3761.01, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3761.01, "10th_percentile": 3761.01, "90th_percentile": 3761.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3458.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 3458.4, "10th_percentile": 3458.4, "90th_percentile": 3458.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2526.36, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2526.36, "10th_percentile": 2526.36, "90th_percentile": 2526.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2723.49, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2723.49, "10th_percentile": 2723.49, "90th_percentile": 2723.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2031.81, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2031.81, "10th_percentile": 2031.81, "90th_percentile": 2031.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2349.55, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2349.55, "10th_percentile": 2349.55, "90th_percentile": 2349.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2593.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2593.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2593.8, "10th_percentile": 2593.8, "90th_percentile": 2593.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 2593.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 2593.8, "10th_percentile": 2593.8, "90th_percentile": 2593.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4323.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4323.0, "10th_percentile": 4323.0, "90th_percentile": 4323.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4323.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4323.0, "10th_percentile": 4323.0, "90th_percentile": 4323.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4323.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4323.0, "10th_percentile": 4323.0, "90th_percentile": 4323.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4323.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4323.0, "10th_percentile": 4323.0, "90th_percentile": 4323.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4323.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4323.0, "10th_percentile": 4323.0, "90th_percentile": 4323.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB CT Angiograph Pelv W/O&W/Dye", "code_information": [ { "code": "PX-35200017", "type": "CDM" }, { "code": "72191", "type": "CPT" }, { "code": "0352", "type": "RC" } ], "standard_charges": [ { "minimum": 2029.44, "maximum": 4832.0, "setting": "outpatient", "gross_charge": 4832.0, "discounted_cash": 3382.4, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,832.00 @ 12.5% = $604.00 due to $0.00 Claim Price", "median_amount": 604.0, "10th_percentile": 604.0, "90th_percentile": 604.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,832.00 @ 12.5% = $604.00 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,832.00 @ 12.5% = $604.00 due to $0.00 Claim Price", "median_amount": 604.0, "10th_percentile": 604.0, "90th_percentile": 604.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,832.00 @ 12.5% = $604.00 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,832.00 @ 12.5% = $604.00 due to $0.00 Claim Price", "median_amount": 604.0, "10th_percentile": 604.0, "90th_percentile": 604.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,832.00 @ 12.5% = $604.00 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2899.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 3140.8, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2966.85, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 2966.85, "10th_percentile": 2966.85, "90th_percentile": 2966.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2899.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 2899.2, "10th_percentile": 2899.2, "90th_percentile": 2899.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2701.09, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2701.09, "10th_percentile": 2701.09, "90th_percentile": 2701.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2823.82, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2823.82, "10th_percentile": 2823.82, "90th_percentile": 2823.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2633.44, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2633.44, "10th_percentile": 2633.44, "90th_percentile": 2633.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2633.44, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2633.44, "10th_percentile": 2633.44, "90th_percentile": 2633.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2633.44, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2633.44, "10th_percentile": 2633.44, "90th_percentile": 2633.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2029.44, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2029.44, "10th_percentile": 2029.44, "90th_percentile": 2029.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2029.44, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2029.44, "10th_percentile": 2029.44, "90th_percentile": 2029.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 2966.85, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 2966.85, "10th_percentile": 2966.85, "90th_percentile": 2966.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2416.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2416.0, "10th_percentile": 2416.0, "90th_percentile": 2416.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 3232.61, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3232.61, "10th_percentile": 3232.61, "90th_percentile": 3232.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 4203.84, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 4203.84, "10th_percentile": 4203.84, "90th_percentile": 4203.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3865.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 3865.6, "10th_percentile": 3865.6, "90th_percentile": 3865.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2823.82, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2823.82, "10th_percentile": 2823.82, "90th_percentile": 2823.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 3044.16, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 3044.16, "10th_percentile": 3044.16, "90th_percentile": 3044.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2271.04, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2271.04, "10th_percentile": 2271.04, "90th_percentile": 2271.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2626.19, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2626.19, "10th_percentile": 2626.19, "90th_percentile": 2626.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2899.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2899.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2899.2, "10th_percentile": 2899.2, "90th_percentile": 2899.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 2899.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 2899.2, "10th_percentile": 2899.2, "90th_percentile": 2899.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4832.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4832.0, "10th_percentile": 4832.0, "90th_percentile": 4832.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4832.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4832.0, "10th_percentile": 4832.0, "90th_percentile": 4832.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4832.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4832.0, "10th_percentile": 4832.0, "90th_percentile": 4832.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4832.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4832.0, "10th_percentile": 4832.0, "90th_percentile": 4832.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4832.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4832.0, "10th_percentile": 4832.0, "90th_percentile": 4832.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB CT Angiography Chest", "code_information": [ { "code": "PX-35200007", "type": "CDM" }, { "code": "71275", "type": "CPT" }, { "code": "0352", "type": "RC" } ], "standard_charges": [ { "minimum": 2101.68, "maximum": 5004.0, "setting": "outpatient", "gross_charge": 5004.0, "discounted_cash": 3502.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,004.00 @ 12.5% = $625.50 due to $0.00 Claim Price", "median_amount": 625.5, "10th_percentile": 625.5, "90th_percentile": 625.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,004.00 @ 12.5% = $625.50 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,004.00 @ 12.5% = $625.50 due to $0.00 Claim Price", "median_amount": 625.5, "10th_percentile": 625.5, "90th_percentile": 625.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,004.00 @ 12.5% = $625.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,004.00 @ 12.5% = $625.50 due to $0.00 Claim Price", "median_amount": 625.5, "10th_percentile": 625.5, "90th_percentile": 625.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,004.00 @ 12.5% = $625.50 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3002.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 3252.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3072.46, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3072.46, "10th_percentile": 3072.46, "90th_percentile": 3072.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 3002.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3002.4, "10th_percentile": 3002.4, "90th_percentile": 3002.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2797.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2797.24, "10th_percentile": 2797.24, "90th_percentile": 2797.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2924.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2924.34, "10th_percentile": 2924.34, "90th_percentile": 2924.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2727.18, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2727.18, "10th_percentile": 2727.18, "90th_percentile": 2727.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2727.18, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2727.18, "10th_percentile": 2727.18, "90th_percentile": 2727.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2727.18, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2727.18, "10th_percentile": 2727.18, "90th_percentile": 2727.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2101.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2101.68, "10th_percentile": 2101.68, "90th_percentile": 2101.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2101.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2101.68, "10th_percentile": 2101.68, "90th_percentile": 2101.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3072.46, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3072.46, "10th_percentile": 3072.46, "90th_percentile": 3072.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2502.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2502.0, "10th_percentile": 2502.0, "90th_percentile": 2502.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 3347.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3347.68, "10th_percentile": 3347.68, "90th_percentile": 3347.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 4353.48, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 4353.48, "10th_percentile": 4353.48, "90th_percentile": 4353.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 4003.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 4003.2, "10th_percentile": 4003.2, "90th_percentile": 4003.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2924.34, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2924.34, "10th_percentile": 2924.34, "90th_percentile": 2924.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 3152.52, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 3152.52, "10th_percentile": 3152.52, "90th_percentile": 3152.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2351.88, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2351.88, "10th_percentile": 2351.88, "90th_percentile": 2351.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2719.67, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2719.67, "10th_percentile": 2719.67, "90th_percentile": 2719.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3002.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 3002.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3002.4, "10th_percentile": 3002.4, "90th_percentile": 3002.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 3002.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3002.4, "10th_percentile": 3002.4, "90th_percentile": 3002.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5004.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5004.0, "10th_percentile": 5004.0, "90th_percentile": 5004.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5004.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5004.0, "10th_percentile": 5004.0, "90th_percentile": 5004.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5004.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5004.0, "10th_percentile": 5004.0, "90th_percentile": 5004.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5004.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5004.0, "10th_percentile": 5004.0, "90th_percentile": 5004.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5004.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5004.0, "10th_percentile": 5004.0, "90th_percentile": 5004.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB CT Angiography Neck", "code_information": [ { "code": "PX-35100010", "type": "CDM" }, { "code": "70498", "type": "CPT" }, { "code": "0351", "type": "RC" } ], "standard_charges": [ { "minimum": 2284.8, "maximum": 5440.0, "setting": "outpatient", "gross_charge": 5440.0, "discounted_cash": 3808.0, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,440.00 @ 12.5% = $680.00 due to $0.00 Claim Price", "median_amount": 680.0, "10th_percentile": 680.0, "90th_percentile": 680.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,440.00 @ 12.5% = $680.00 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,440.00 @ 12.5% = $680.00 due to $0.00 Claim Price", "median_amount": 680.0, "10th_percentile": 680.0, "90th_percentile": 680.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,440.00 @ 12.5% = $680.00 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,440.00 @ 12.5% = $680.00 due to $0.00 Claim Price", "median_amount": 680.0, "10th_percentile": 680.0, "90th_percentile": 680.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,440.00 @ 12.5% = $680.00 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3264.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 3536.0, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3340.16, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3340.16, "10th_percentile": 3340.16, "90th_percentile": 3340.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 3264.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3264.0, "10th_percentile": 3264.0, "90th_percentile": 3264.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3040.96, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 3040.96, "10th_percentile": 3040.96, "90th_percentile": 3040.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3179.14, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3179.14, "10th_percentile": 3179.14, "90th_percentile": 3179.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2964.8, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2964.8, "10th_percentile": 2964.8, "90th_percentile": 2964.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2964.8, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2964.8, "10th_percentile": 2964.8, "90th_percentile": 2964.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2964.8, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2964.8, "10th_percentile": 2964.8, "90th_percentile": 2964.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2284.8, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2284.8, "10th_percentile": 2284.8, "90th_percentile": 2284.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2284.8, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2284.8, "10th_percentile": 2284.8, "90th_percentile": 2284.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3340.16, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3340.16, "10th_percentile": 3340.16, "90th_percentile": 3340.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2720.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2720.0, "10th_percentile": 2720.0, "90th_percentile": 2720.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 3639.36, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3639.36, "10th_percentile": 3639.36, "90th_percentile": 3639.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 4732.8, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 4732.8, "10th_percentile": 4732.8, "90th_percentile": 4732.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 4352.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 4352.0, "10th_percentile": 4352.0, "90th_percentile": 4352.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3179.14, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3179.14, "10th_percentile": 3179.14, "90th_percentile": 3179.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 3427.2, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 3427.2, "10th_percentile": 3427.2, "90th_percentile": 3427.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2556.8, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2556.8, "10th_percentile": 2556.8, "90th_percentile": 2556.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2956.64, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2956.64, "10th_percentile": 2956.64, "90th_percentile": 2956.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3264.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 3264.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3264.0, "10th_percentile": 3264.0, "90th_percentile": 3264.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 3264.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3264.0, "10th_percentile": 3264.0, "90th_percentile": 3264.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5440.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5440.0, "10th_percentile": 5440.0, "90th_percentile": 5440.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5440.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5440.0, "10th_percentile": 5440.0, "90th_percentile": 5440.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5440.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5440.0, "10th_percentile": 5440.0, "90th_percentile": 5440.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5440.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5440.0, "10th_percentile": 5440.0, "90th_percentile": 5440.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5440.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5440.0, "10th_percentile": 5440.0, "90th_percentile": 5440.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB CT Head/Brain W/O & W/Dye", "code_information": [ { "code": "PX-35100002", "type": "CDM" }, { "code": "70470", "type": "CPT" }, { "code": "0351", "type": "RC" } ], "standard_charges": [ { "minimum": 2254.14, "maximum": 5367.0, "setting": "outpatient", "gross_charge": 5367.0, "discounted_cash": 3756.9, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,367.00 @ 12.5% = $670.88 due to $0.00 Claim Price", "median_amount": 670.88, "10th_percentile": 670.88, "90th_percentile": 670.88, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,367.00 @ 12.5% = $670.88 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,367.00 @ 12.5% = $670.88 due to $0.00 Claim Price", "median_amount": 670.88, "10th_percentile": 670.88, "90th_percentile": 670.88, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,367.00 @ 12.5% = $670.88 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,367.00 @ 12.5% = $670.88 due to $0.00 Claim Price", "median_amount": 670.88, "10th_percentile": 670.88, "90th_percentile": 670.88, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,367.00 @ 12.5% = $670.88 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3220.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 3488.55, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3295.34, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3295.34, "10th_percentile": 3295.34, "90th_percentile": 3295.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 3220.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3220.2, "10th_percentile": 3220.2, "90th_percentile": 3220.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3000.15, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 3000.15, "10th_percentile": 3000.15, "90th_percentile": 3000.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3136.47, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3136.47, "10th_percentile": 3136.47, "90th_percentile": 3136.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2925.02, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2925.02, "10th_percentile": 2925.02, "90th_percentile": 2925.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2925.02, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2925.02, "10th_percentile": 2925.02, "90th_percentile": 2925.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2925.02, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 2925.02, "10th_percentile": 2925.02, "90th_percentile": 2925.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2254.14, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2254.14, "10th_percentile": 2254.14, "90th_percentile": 2254.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2254.14, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2254.14, "10th_percentile": 2254.14, "90th_percentile": 2254.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3295.34, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3295.34, "10th_percentile": 3295.34, "90th_percentile": 3295.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2683.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2683.5, "10th_percentile": 2683.5, "90th_percentile": 2683.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 3590.52, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 4669.29, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 4669.29, "10th_percentile": 4669.29, "90th_percentile": 4669.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 4293.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 4293.6, "10th_percentile": 4293.6, "90th_percentile": 4293.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3136.47, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3136.47, "10th_percentile": 3136.47, "90th_percentile": 3136.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 3381.21, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 3381.21, "10th_percentile": 3381.21, "90th_percentile": 3381.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2522.49, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2522.49, "10th_percentile": 2522.49, "90th_percentile": 2522.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 2916.96, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2916.96, "10th_percentile": 2916.96, "90th_percentile": 2916.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3220.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 3220.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3220.2, "10th_percentile": 3220.2, "90th_percentile": 3220.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 3220.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3220.2, "10th_percentile": 3220.2, "90th_percentile": 3220.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5367.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5367.0, "10th_percentile": 5367.0, "90th_percentile": 5367.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5367.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5367.0, "10th_percentile": 5367.0, "90th_percentile": 5367.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5367.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5367.0, "10th_percentile": 5367.0, "90th_percentile": 5367.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5367.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5367.0, "10th_percentile": 5367.0, "90th_percentile": 5367.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5367.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5367.0, "10th_percentile": 5367.0, "90th_percentile": 5367.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB CT Scan for Therapy Guide", "code_information": [ { "code": "PX-35000012", "type": "CDM" }, { "code": "77014", "type": "CPT" }, { "code": "0350", "type": "RC" } ], "standard_charges": [ { "minimum": 897.96, "maximum": 2138.0, "setting": "outpatient", "gross_charge": 2138.0, "discounted_cash": 1496.6, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,138.00 @ 12.5% = $267.25 due to $0.00 Claim Price", "median_amount": 267.25, "10th_percentile": 267.25, "90th_percentile": 267.25, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,138.00 @ 12.5% = $267.25 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,138.00 @ 12.5% = $267.25 due to $0.00 Claim Price", "median_amount": 267.25, "10th_percentile": 267.25, "90th_percentile": 267.25, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,138.00 @ 12.5% = $267.25 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,138.00 @ 12.5% = $267.25 due to $0.00 Claim Price", "median_amount": 267.25, "10th_percentile": 267.25, "90th_percentile": 267.25, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,138.00 @ 12.5% = $267.25 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1282.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 1389.7, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 1312.73, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 1312.73, "10th_percentile": 1312.73, "90th_percentile": 1312.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 1282.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1282.8, "10th_percentile": 1282.8, "90th_percentile": 1282.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1195.14, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 1195.14, "10th_percentile": 1195.14, "90th_percentile": 1195.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1249.45, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1249.45, "10th_percentile": 1249.45, "90th_percentile": 1249.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1165.21, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 1165.21, "10th_percentile": 1165.21, "90th_percentile": 1165.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1165.21, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 1165.21, "10th_percentile": 1165.21, "90th_percentile": 1165.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1165.21, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 1165.21, "10th_percentile": 1165.21, "90th_percentile": 1165.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 897.96, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 897.96, "10th_percentile": 897.96, "90th_percentile": 897.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 897.96, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 897.96, "10th_percentile": 897.96, "90th_percentile": 897.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 1312.73, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 1312.73, "10th_percentile": 1312.73, "90th_percentile": 1312.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 1069.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 1069.0, "10th_percentile": 1069.0, "90th_percentile": 1069.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 1430.32, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1430.32, "10th_percentile": 1430.32, "90th_percentile": 1430.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 1860.06, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 1860.06, "10th_percentile": 1860.06, "90th_percentile": 1860.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 1710.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 1710.4, "10th_percentile": 1710.4, "90th_percentile": 1710.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1249.45, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1249.45, "10th_percentile": 1249.45, "90th_percentile": 1249.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 1346.94, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 1346.94, "10th_percentile": 1346.94, "90th_percentile": 1346.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1004.86, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1004.86, "10th_percentile": 1004.86, "90th_percentile": 1004.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 1162.0, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 1162.0, "10th_percentile": 1162.0, "90th_percentile": 1162.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1282.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 1282.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1282.8, "10th_percentile": 1282.8, "90th_percentile": 1282.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 1282.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1282.8, "10th_percentile": 1282.8, "90th_percentile": 1282.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2138.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2138.0, "10th_percentile": 2138.0, "90th_percentile": 2138.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2138.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2138.0, "10th_percentile": 2138.0, "90th_percentile": 2138.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2138.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2138.0, "10th_percentile": 2138.0, "90th_percentile": 2138.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2138.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2138.0, "10th_percentile": 2138.0, "90th_percentile": 2138.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2138.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2138.0, "10th_percentile": 2138.0, "90th_percentile": 2138.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Canalith Repositioning Proc", "code_information": [ { "code": "PX-47000010", "type": "CDM" }, { "code": "95992", "type": "CPT" }, { "code": "0470", "type": "RC" } ], "standard_charges": [ { "minimum": 96.6, "maximum": 230.0, "setting": "outpatient", "gross_charge": 230.0, "discounted_cash": 161.0, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $230.00 @ 12.5% = $28.75 due to $0.00 Claim Price", "median_amount": 28.75, "10th_percentile": 28.75, "90th_percentile": 28.75, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $230.00 @ 12.5% = $28.75 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $230.00 @ 12.5% = $28.75 due to $0.00 Claim Price", "median_amount": 28.75, "10th_percentile": 28.75, "90th_percentile": 28.75, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $230.00 @ 12.5% = $28.75 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $230.00 @ 12.5% = $28.75 due to $0.00 Claim Price", "median_amount": 28.75, "10th_percentile": 28.75, "90th_percentile": 28.75, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $230.00 @ 12.5% = $28.75 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 149.5, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 149.5, "10th_percentile": 149.5, "90th_percentile": 149.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 138.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 138.0, "10th_percentile": 138.0, "90th_percentile": 138.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 141.22, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 141.22, "10th_percentile": 141.22, "90th_percentile": 141.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 138.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 138.0, "10th_percentile": 138.0, "90th_percentile": 138.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 128.57, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 128.57, "10th_percentile": 128.57, "90th_percentile": 128.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 134.41, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.41, "10th_percentile": 134.41, "90th_percentile": 134.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 125.35, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 125.35, "10th_percentile": 125.35, "90th_percentile": 125.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 125.35, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 125.35, "10th_percentile": 125.35, "90th_percentile": 125.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 125.35, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 125.35, "10th_percentile": 125.35, "90th_percentile": 125.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 96.6, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 96.6, "10th_percentile": 96.6, "90th_percentile": 96.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 96.6, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 96.6, "10th_percentile": 96.6, "90th_percentile": 96.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 141.22, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 141.22, "10th_percentile": 141.22, "90th_percentile": 141.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 115.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 115.0, "10th_percentile": 115.0, "90th_percentile": 115.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 153.87, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 153.87, "10th_percentile": 153.87, "90th_percentile": 153.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 200.1, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 200.1, "10th_percentile": 200.1, "90th_percentile": 200.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 184.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 184.0, "10th_percentile": 184.0, "90th_percentile": 184.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 134.41, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.41, "10th_percentile": 134.41, "90th_percentile": 134.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 144.9, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 144.9, "10th_percentile": 144.9, "90th_percentile": 144.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 108.1, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 108.1, "10th_percentile": 108.1, "90th_percentile": 108.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 125.01, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 125.01, "10th_percentile": 125.01, "90th_percentile": 125.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 138.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 138.0, "10th_percentile": 138.0, "90th_percentile": 138.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 138.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 138.0, "10th_percentile": 138.0, "90th_percentile": 138.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 138.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 138.0, "10th_percentile": 138.0, "90th_percentile": 138.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 230.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 230.0, "10th_percentile": 230.0, "90th_percentile": 230.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 230.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 230.0, "10th_percentile": 230.0, "90th_percentile": 230.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 230.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 230.0, "10th_percentile": 230.0, "90th_percentile": 230.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 230.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 230.0, "10th_percentile": 230.0, "90th_percentile": 230.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 230.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 230.0, "10th_percentile": 230.0, "90th_percentile": 230.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Capillary Blood Gas Epoc", "code_information": [ { "code": "PX-30001250", "type": "CDM" }, { "code": "82803", "type": "CPT" }, { "code": "0301", "type": "RC" } ], "standard_charges": [ { "minimum": 179.76, "maximum": 428.0, "setting": "outpatient", "gross_charge": 428.0, "discounted_cash": 299.6, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $428.00 @ 12.5% = $53.50 due to $0.00 Claim Price", "median_amount": 53.5, "10th_percentile": 53.5, "90th_percentile": 53.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $428.00 @ 12.5% = $53.50 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $428.00 @ 12.5% = $53.50 due to $0.00 Claim Price", "median_amount": 53.5, "10th_percentile": 53.5, "90th_percentile": 53.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $428.00 @ 12.5% = $53.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $428.00 @ 12.5% = $53.50 due to $0.00 Claim Price", "median_amount": 53.5, "10th_percentile": 53.5, "90th_percentile": 53.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $428.00 @ 12.5% = $53.50 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 179.76, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 179.76, "10th_percentile": 179.76, "90th_percentile": 179.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 179.76, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 179.76, "10th_percentile": 179.76, "90th_percentile": 179.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 256.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 256.8, "10th_percentile": 256.8, "90th_percentile": 256.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 256.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 256.8, "10th_percentile": 256.8, "90th_percentile": 256.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 256.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 256.8, "10th_percentile": 256.8, "90th_percentile": 256.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 201.16, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 201.16, "10th_percentile": 201.16, "90th_percentile": 201.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 269.64, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 269.64, "10th_percentile": 269.64, "90th_percentile": 269.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 232.62, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 232.62, "10th_percentile": 232.62, "90th_percentile": 232.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 214.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 214.0, "10th_percentile": 214.0, "90th_percentile": 214.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 250.12, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 250.12, "10th_percentile": 250.12, "90th_percentile": 250.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 262.79, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 262.79, "10th_percentile": 262.79, "90th_percentile": 262.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 342.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 342.4, "10th_percentile": 342.4, "90th_percentile": 342.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 372.36, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 372.36, "10th_percentile": 372.36, "90th_percentile": 372.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 278.2, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 278.2, "10th_percentile": 278.2, "90th_percentile": 278.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 286.33, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 286.33, "10th_percentile": 286.33, "90th_percentile": 286.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 278.2, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 278.2, "10th_percentile": 278.2, "90th_percentile": 278.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 278.2, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 278.2, "10th_percentile": 278.2, "90th_percentile": 278.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 256.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 256.8, "10th_percentile": 256.8, "90th_percentile": 256.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 256.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 256.8, "10th_percentile": 256.8, "90th_percentile": 256.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 262.79, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 262.79, "10th_percentile": 262.79, "90th_percentile": 262.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 250.12, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 250.12, "10th_percentile": 250.12, "90th_percentile": 250.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 239.25, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 239.25, "10th_percentile": 239.25, "90th_percentile": 239.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 233.26, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 233.26, "10th_percentile": 233.26, "90th_percentile": 233.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 233.26, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 233.26, "10th_percentile": 233.26, "90th_percentile": 233.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 233.26, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 233.26, "10th_percentile": 233.26, "90th_percentile": 233.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 428.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 428.0, "10th_percentile": 428.0, "90th_percentile": 428.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 428.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 428.0, "10th_percentile": 428.0, "90th_percentile": 428.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 428.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 428.0, "10th_percentile": 428.0, "90th_percentile": 428.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 428.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 428.0, "10th_percentile": 428.0, "90th_percentile": 428.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 428.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 428.0, "10th_percentile": 428.0, "90th_percentile": 428.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Car-T Therapy Hrvg Bld-Drv T Lymphcyt PR Day", "code_information": [ { "code": "PX-87100001", "type": "CDM" }, { "code": "38225", "type": "CPT" }, { "code": "0871", "type": "RC" } ], "standard_charges": [ { "minimum": 2363.34, "maximum": 5627.0, "setting": "outpatient", "gross_charge": 5627.0, "discounted_cash": 3938.9, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_algorithm": "No contract line matched", "median_amount": 5627.0, "10th_percentile": 5627.0, "90th_percentile": 5627.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 5627.0, "10th_percentile": 5627.0, "90th_percentile": 5627.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,627.00 @ 12.5% = $703.38 due to $0.00 Claim Price", "median_amount": 703.38, "10th_percentile": 703.38, "90th_percentile": 703.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,627.00 @ 12.5% = $703.38 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,627.00 @ 12.5% = $703.38 due to $0.00 Claim Price", "median_amount": 703.38, "10th_percentile": 703.38, "90th_percentile": 703.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,627.00 @ 12.5% = $703.38 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,627.00 @ 12.5% = $703.38 due to $0.00 Claim Price", "median_amount": 703.38, "10th_percentile": 703.38, "90th_percentile": 703.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,627.00 @ 12.5% = $703.38 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3376.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 3657.55, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 3657.55, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 3657.55, "10th_percentile": 3657.55, "90th_percentile": 3657.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3454.98, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3454.98, "10th_percentile": 3454.98, "90th_percentile": 3454.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 3376.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3376.2, "10th_percentile": 3376.2, "90th_percentile": 3376.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3145.49, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 3145.49, "10th_percentile": 3145.49, "90th_percentile": 3145.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3288.42, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3288.42, "10th_percentile": 3288.42, "90th_percentile": 3288.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 3066.72, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3066.72, "10th_percentile": 3066.72, "90th_percentile": 3066.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 3066.72, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3066.72, "10th_percentile": 3066.72, "90th_percentile": 3066.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3066.72, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3066.72, "10th_percentile": 3066.72, "90th_percentile": 3066.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2363.34, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2363.34, "10th_percentile": 2363.34, "90th_percentile": 2363.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2363.34, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2363.34, "10th_percentile": 2363.34, "90th_percentile": 2363.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 3657.55, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 3657.55, "10th_percentile": 3657.55, "90th_percentile": 3657.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3454.98, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3454.98, "10th_percentile": 3454.98, "90th_percentile": 3454.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2813.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2813.5, "10th_percentile": 2813.5, "90th_percentile": 2813.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 3764.46, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3764.46, "10th_percentile": 3764.46, "90th_percentile": 3764.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 4895.49, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 4895.49, "10th_percentile": 4895.49, "90th_percentile": 4895.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 4501.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 4501.6, "10th_percentile": 4501.6, "90th_percentile": 4501.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3288.42, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3288.42, "10th_percentile": 3288.42, "90th_percentile": 3288.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 3545.01, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 3545.01, "10th_percentile": 3545.01, "90th_percentile": 3545.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2644.69, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2644.69, "10th_percentile": 2644.69, "90th_percentile": 2644.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 3058.27, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 3058.27, "10th_percentile": 3058.27, "90th_percentile": 3058.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3376.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 3376.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3376.2, "10th_percentile": 3376.2, "90th_percentile": 3376.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 3376.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3376.2, "10th_percentile": 3376.2, "90th_percentile": 3376.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5627.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5627.0, "10th_percentile": 5627.0, "90th_percentile": 5627.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5627.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5627.0, "10th_percentile": 5627.0, "90th_percentile": 5627.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5627.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5627.0, "10th_percentile": 5627.0, "90th_percentile": 5627.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5627.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5627.0, "10th_percentile": 5627.0, "90th_percentile": 5627.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5627.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5627.0, "10th_percentile": 5627.0, "90th_percentile": 5627.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Case Management; Each 15 Minutes; Cc Consult", "code_information": [ { "code": "PX-99000002", "type": "CDM" }, { "code": "T1016", "type": "HCPCS" }, { "code": "0990", "type": "RC" } ], "standard_charges": [ { "minimum": 31.5, "maximum": 75.0, "setting": "outpatient", "gross_charge": 75.0, "discounted_cash": 52.5, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_algorithm": "No contract line matched", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "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": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 48.75, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 48.75, "10th_percentile": 48.75, "90th_percentile": 48.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 45.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 43.26, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 43.26, "10th_percentile": 43.26, "90th_percentile": 43.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 38.22, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 38.22, "10th_percentile": 38.22, "90th_percentile": 38.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 48.75, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 48.75, "10th_percentile": 48.75, "90th_percentile": 48.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 41.93, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 41.93, "10th_percentile": 41.93, "90th_percentile": 41.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 45.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 43.83, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 43.83, "10th_percentile": 43.83, "90th_percentile": 43.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 36.4, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 36.4, "10th_percentile": 36.4, "90th_percentile": 36.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 36.4, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 36.4, "10th_percentile": 36.4, "90th_percentile": 36.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 45.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 45.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 45.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 37.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 37.5, "10th_percentile": 37.5, "90th_percentile": 37.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 35.25, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 35.25, "10th_percentile": 35.25, "90th_percentile": 35.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 40.76, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 40.76, "10th_percentile": 40.76, "90th_percentile": 40.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 43.83, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 43.83, "10th_percentile": 43.83, "90th_percentile": 43.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 65.25, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 65.25, "10th_percentile": 65.25, "90th_percentile": 65.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 47.25, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 47.25, "10th_percentile": 47.25, "90th_percentile": 47.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 50.18, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 50.18, "10th_percentile": 50.18, "90th_percentile": 50.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH PHCS", "standard_charge_dollar": 60.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 60.0, "10th_percentile": 60.0, "90th_percentile": 60.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 48.75, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 48.75, "10th_percentile": 48.75, "90th_percentile": 48.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 43.26, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 43.26, "10th_percentile": 43.26, "90th_percentile": 43.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 31.5, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 31.5, "10th_percentile": 31.5, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 31.5, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 31.5, "10th_percentile": 31.5, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 75.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 75.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 75.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 75.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 75.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Case Management; Each 15 Minutes; Mental Health", "code_information": [ { "code": "PX-99000003", "type": "CDM" }, { "code": "T1016", "type": "HCPCS" }, { "code": "0990", "type": "RC" } ], "standard_charges": [ { "minimum": 31.5, "maximum": 75.0, "setting": "outpatient", "gross_charge": 75.0, "discounted_cash": 52.5, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_algorithm": "No contract line matched", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "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": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 48.75, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 48.75, "10th_percentile": 48.75, "90th_percentile": 48.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 45.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 43.26, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 43.26, "10th_percentile": 43.26, "90th_percentile": 43.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 38.22, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 38.22, "10th_percentile": 38.22, "90th_percentile": 38.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 48.75, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 48.75, "10th_percentile": 48.75, "90th_percentile": 48.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 41.93, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 41.93, "10th_percentile": 41.93, "90th_percentile": 41.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 45.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 43.83, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 43.83, "10th_percentile": 43.83, "90th_percentile": 43.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 36.4, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 36.4, "10th_percentile": 36.4, "90th_percentile": 36.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 36.4, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 36.4, "10th_percentile": 36.4, "90th_percentile": 36.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 45.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 45.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 45.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 37.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 37.5, "10th_percentile": 37.5, "90th_percentile": 37.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 35.25, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 35.25, "10th_percentile": 35.25, "90th_percentile": 35.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 40.76, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 40.76, "10th_percentile": 40.76, "90th_percentile": 40.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 43.83, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 43.83, "10th_percentile": 43.83, "90th_percentile": 43.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 65.25, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 65.25, "10th_percentile": 65.25, "90th_percentile": 65.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 47.25, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 47.25, "10th_percentile": 47.25, "90th_percentile": 47.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 50.18, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 50.18, "10th_percentile": 50.18, "90th_percentile": 50.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH PHCS", "standard_charge_dollar": 60.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 60.0, "10th_percentile": 60.0, "90th_percentile": 60.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 48.75, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 48.75, "10th_percentile": 48.75, "90th_percentile": 48.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 43.26, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 43.26, "10th_percentile": 43.26, "90th_percentile": 43.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 31.5, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 31.5, "10th_percentile": 31.5, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 31.5, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 31.5, "10th_percentile": 31.5, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 75.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 75.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 75.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 75.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 75.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Case Management; Each 15 Minutes; Transition/Linkage", "code_information": [ { "code": "PX-99000004", "type": "CDM" }, { "code": "T1016", "type": "HCPCS" }, { "code": "0990", "type": "RC" } ], "standard_charges": [ { "minimum": 31.5, "maximum": 75.0, "setting": "outpatient", "gross_charge": 75.0, "discounted_cash": 52.5, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_algorithm": "No contract line matched", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "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": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 48.75, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 48.75, "10th_percentile": 48.75, "90th_percentile": 48.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 45.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 43.26, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 43.26, "10th_percentile": 43.26, "90th_percentile": 43.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 38.22, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 38.22, "10th_percentile": 38.22, "90th_percentile": 38.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 48.75, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 48.75, "10th_percentile": 48.75, "90th_percentile": 48.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 41.93, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 41.93, "10th_percentile": 41.93, "90th_percentile": 41.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 45.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 43.83, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 43.83, "10th_percentile": 43.83, "90th_percentile": 43.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 36.4, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 36.4, "10th_percentile": 36.4, "90th_percentile": 36.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 36.4, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 36.4, "10th_percentile": 36.4, "90th_percentile": 36.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 45.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 45.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 45.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 37.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 37.5, "10th_percentile": 37.5, "90th_percentile": 37.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 35.25, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 35.25, "10th_percentile": 35.25, "90th_percentile": 35.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 40.76, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 40.76, "10th_percentile": 40.76, "90th_percentile": 40.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 43.83, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 43.83, "10th_percentile": 43.83, "90th_percentile": 43.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 65.25, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 65.25, "10th_percentile": 65.25, "90th_percentile": 65.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 47.25, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 47.25, "10th_percentile": 47.25, "90th_percentile": 47.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 50.18, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 50.18, "10th_percentile": 50.18, "90th_percentile": 50.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH PHCS", "standard_charge_dollar": 60.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 60.0, "10th_percentile": 60.0, "90th_percentile": 60.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 48.75, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 48.75, "10th_percentile": 48.75, "90th_percentile": 48.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 43.26, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 43.26, "10th_percentile": 43.26, "90th_percentile": 43.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 31.5, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 31.5, "10th_percentile": 31.5, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 31.5, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 31.5, "10th_percentile": 31.5, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 75.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 75.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 75.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 75.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 75.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Cell Count, Body Fluid or CSF W/Differential", "code_information": [ { "code": "PX-30511390", "type": "CDM" }, { "code": "89051", "type": "CPT" }, { "code": "0300", "type": "RC" } ], "standard_charges": [ { "minimum": 60.48, "maximum": 144.0, "setting": "outpatient", "gross_charge": 144.0, "discounted_cash": 100.8, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $144.00 @ 12.5% = $18.00 due to $0.00 Claim Price", "median_amount": 18.0, "10th_percentile": 18.0, "90th_percentile": 18.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $144.00 @ 12.5% = $18.00 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $144.00 @ 12.5% = $18.00 due to $0.00 Claim Price", "median_amount": 18.0, "10th_percentile": 18.0, "90th_percentile": 18.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $144.00 @ 12.5% = $18.00 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $144.00 @ 12.5% = $18.00 due to $0.00 Claim Price", "median_amount": 18.0, "10th_percentile": 18.0, "90th_percentile": 18.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $144.00 @ 12.5% = $18.00 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 93.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 93.6, "10th_percentile": 93.6, "90th_percentile": 93.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 86.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 86.4, "10th_percentile": 86.4, "90th_percentile": 86.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 93.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 93.6, "10th_percentile": 93.6, "90th_percentile": 93.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 88.42, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 88.42, "10th_percentile": 88.42, "90th_percentile": 88.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 86.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 86.4, "10th_percentile": 86.4, "90th_percentile": 86.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 80.5, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 80.5, "10th_percentile": 80.5, "90th_percentile": 80.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 84.15, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 84.15, "10th_percentile": 84.15, "90th_percentile": 84.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 78.48, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 78.48, "10th_percentile": 78.48, "90th_percentile": 78.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 78.48, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 78.48, "10th_percentile": 78.48, "90th_percentile": 78.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 78.48, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 78.48, "10th_percentile": 78.48, "90th_percentile": 78.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 60.48, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 60.48, "10th_percentile": 60.48, "90th_percentile": 60.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 60.48, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 60.48, "10th_percentile": 60.48, "90th_percentile": 60.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 93.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 93.6, "10th_percentile": 93.6, "90th_percentile": 93.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 88.42, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 88.42, "10th_percentile": 88.42, "90th_percentile": 88.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 72.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 72.0, "10th_percentile": 72.0, "90th_percentile": 72.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 96.34, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.34, "10th_percentile": 96.34, "90th_percentile": 96.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 125.28, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 125.28, "10th_percentile": 125.28, "90th_percentile": 125.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 115.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 115.2, "10th_percentile": 115.2, "90th_percentile": 115.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 84.15, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 84.15, "10th_percentile": 84.15, "90th_percentile": 84.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 90.72, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 90.72, "10th_percentile": 90.72, "90th_percentile": 90.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 67.68, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 67.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 78.26, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 78.26, "10th_percentile": 78.26, "90th_percentile": 78.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 86.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 86.4, "10th_percentile": 86.4, "90th_percentile": 86.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 86.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 86.4, "10th_percentile": 86.4, "90th_percentile": 86.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 86.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 86.4, "10th_percentile": 86.4, "90th_percentile": 86.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 144.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% 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 OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 144.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% 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 OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 144.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% 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 OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 144.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% 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 OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 144.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% 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 OP Services; 100% Billed" } ] } ] }, { "description": "HB Central Line Dressing", "code_information": [ { "code": "PX-27205018", "type": "CDM" }, { "code": "27205018", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 16.8, "maximum": 40.0, "setting": "outpatient", "gross_charge": 40.0, "discounted_cash": 28.0, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_algorithm": "No contract line matched", "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_algorithm": "No contract line matched", "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_algorithm": "No contract line matched", "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_algorithm": "No contract line matched", "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "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": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 26.0, "10th_percentile": 26.0, "90th_percentile": 26.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 24.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 24.0, "10th_percentile": 24.0, "90th_percentile": 24.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 20.38, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 20.38, "10th_percentile": 20.38, "90th_percentile": 20.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 26.0, "10th_percentile": 26.0, "90th_percentile": 26.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 22.36, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 22.36, "10th_percentile": 22.36, "90th_percentile": 22.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 24.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 24.0, "10th_percentile": 24.0, "90th_percentile": 24.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 23.38, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 24.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 24.0, "10th_percentile": 24.0, "90th_percentile": 24.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 24.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 24.0, "10th_percentile": 24.0, "90th_percentile": 24.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 24.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 24.0, "10th_percentile": 24.0, "90th_percentile": 24.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 25.2, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 25.2, "10th_percentile": 25.2, "90th_percentile": 25.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 18.8, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 18.8, "10th_percentile": 18.8, "90th_percentile": 18.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 26.0, "10th_percentile": 26.0, "90th_percentile": 26.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 21.74, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 21.74, "10th_percentile": 21.74, "90th_percentile": 21.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 34.8, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 34.8, "10th_percentile": 34.8, "90th_percentile": 34.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 26.76, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.76, "10th_percentile": 26.76, "90th_percentile": 26.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS HMO", "standard_charge_dollar": 23.38, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH PHCS", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 32.0, "10th_percentile": 32.0, "90th_percentile": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 20.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 20.0, "10th_percentile": 20.0, "90th_percentile": 20.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH UHC ALL OTHER", "standard_charge_dollar": 19.44, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 19.44, "10th_percentile": 19.44, "90th_percentile": 19.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 19.4, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 19.4, "10th_percentile": 19.4, "90th_percentile": 19.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 16.8, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 16.8, "10th_percentile": 16.8, "90th_percentile": 16.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 16.8, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 16.8, "10th_percentile": 16.8, "90th_percentile": 16.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 40.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 40.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 40.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 40.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 40.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Centrlline Tip Cultr Prep", "code_information": [ { "code": "PX-94000026", "type": "CDM" }, { "code": "94000026", "type": "LOCAL" }, { "code": "0940", "type": "RC" } ], "standard_charges": [ { "minimum": 190.68, "maximum": 454.0, "setting": "outpatient", "gross_charge": 454.0, "discounted_cash": 317.8, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_algorithm": "No contract line matched", "median_amount": 454.0, "10th_percentile": 454.0, "90th_percentile": 454.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 454.0, "10th_percentile": 454.0, "90th_percentile": 454.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 454.0, "10th_percentile": 454.0, "90th_percentile": 454.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 454.0, "10th_percentile": 454.0, "90th_percentile": 454.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 454.0, "10th_percentile": 454.0, "90th_percentile": 454.0, "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": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 295.1, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 295.1, "10th_percentile": 295.1, "90th_percentile": 295.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 272.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 272.4, "10th_percentile": 272.4, "90th_percentile": 272.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 261.87, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 261.87, "10th_percentile": 261.87, "90th_percentile": 261.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 231.36, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 231.36, "10th_percentile": 231.36, "90th_percentile": 231.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 295.1, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 295.1, "10th_percentile": 295.1, "90th_percentile": 295.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 253.79, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 253.79, "10th_percentile": 253.79, "90th_percentile": 253.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 272.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 272.4, "10th_percentile": 272.4, "90th_percentile": 272.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 265.32, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 265.32, "10th_percentile": 265.32, "90th_percentile": 265.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 220.33, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 220.33, "10th_percentile": 220.33, "90th_percentile": 220.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 220.33, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 220.33, "10th_percentile": 220.33, "90th_percentile": 220.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 272.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 272.4, "10th_percentile": 272.4, "90th_percentile": 272.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 272.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 272.4, "10th_percentile": 272.4, "90th_percentile": 272.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 272.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 272.4, "10th_percentile": 272.4, "90th_percentile": 272.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 286.02, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 286.02, "10th_percentile": 286.02, "90th_percentile": 286.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 213.38, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 213.38, "10th_percentile": 213.38, "90th_percentile": 213.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 295.1, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 295.1, "10th_percentile": 295.1, "90th_percentile": 295.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 246.75, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 246.75, "10th_percentile": 246.75, "90th_percentile": 246.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 394.98, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 394.98, "10th_percentile": 394.98, "90th_percentile": 394.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 303.73, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 303.73, "10th_percentile": 303.73, "90th_percentile": 303.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS HMO", "standard_charge_dollar": 265.32, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 265.32, "10th_percentile": 265.32, "90th_percentile": 265.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH PHCS", "standard_charge_dollar": 363.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 363.2, "10th_percentile": 363.2, "90th_percentile": 363.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 261.87, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 261.87, "10th_percentile": 261.87, "90th_percentile": 261.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 227.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 227.0, "10th_percentile": 227.0, "90th_percentile": 227.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 190.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 190.68, "10th_percentile": 190.68, "90th_percentile": 190.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 190.68, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 190.68, "10th_percentile": 190.68, "90th_percentile": 190.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 454.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 454.0, "10th_percentile": 454.0, "90th_percentile": 454.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 454.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 454.0, "10th_percentile": 454.0, "90th_percentile": 454.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 454.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 454.0, "10th_percentile": 454.0, "90th_percentile": 454.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 454.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 454.0, "10th_percentile": 454.0, "90th_percentile": 454.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 454.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 454.0, "10th_percentile": 454.0, "90th_percentile": 454.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Chair Pressure Pad Alarm", "code_information": [ { "code": "PX-27105011", "type": "CDM" }, { "code": "27105011", "type": "LOCAL" }, { "code": "0271", "type": "RC" } ], "standard_charges": [ { "minimum": 23.1, "maximum": 55.0, "setting": "outpatient", "gross_charge": 55.0, "discounted_cash": 38.5, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 55.0, "10th_percentile": 55.0, "90th_percentile": 55.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 55.0, "10th_percentile": 55.0, "90th_percentile": 55.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 55.0, "10th_percentile": 55.0, "90th_percentile": 55.0, "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": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 35.75, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 35.75, "10th_percentile": 35.75, "90th_percentile": 35.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 33.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 33.0, "10th_percentile": 33.0, "90th_percentile": 33.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 31.72, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 31.72, "10th_percentile": 31.72, "90th_percentile": 31.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 28.03, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 28.03, "10th_percentile": 28.03, "90th_percentile": 28.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 35.75, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 35.75, "10th_percentile": 35.75, "90th_percentile": 35.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 30.75, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 30.75, "10th_percentile": 30.75, "90th_percentile": 30.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 33.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 33.0, "10th_percentile": 33.0, "90th_percentile": 33.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 32.14, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 26.69, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 26.69, "10th_percentile": 26.69, "90th_percentile": 26.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 26.69, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 26.69, "10th_percentile": 26.69, "90th_percentile": 26.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 33.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 33.0, "10th_percentile": 33.0, "90th_percentile": 33.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 33.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 33.0, "10th_percentile": 33.0, "90th_percentile": 33.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 33.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 33.0, "10th_percentile": 33.0, "90th_percentile": 33.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 34.65, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 34.65, "10th_percentile": 34.65, "90th_percentile": 34.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 25.85, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 25.85, "10th_percentile": 25.85, "90th_percentile": 25.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 35.75, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 35.75, "10th_percentile": 35.75, "90th_percentile": 35.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 29.89, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 29.89, "10th_percentile": 29.89, "90th_percentile": 29.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 47.85, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 47.85, "10th_percentile": 47.85, "90th_percentile": 47.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 36.8, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 36.8, "10th_percentile": 36.8, "90th_percentile": 36.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS HMO", "standard_charge_dollar": 32.14, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH PHCS", "standard_charge_dollar": 44.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 44.0, "10th_percentile": 44.0, "90th_percentile": 44.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 31.72, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 31.72, "10th_percentile": 31.72, "90th_percentile": 31.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 27.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 27.5, "10th_percentile": 27.5, "90th_percentile": 27.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH UHC ALL OTHER", "standard_charge_dollar": 26.73, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.73, "10th_percentile": 26.73, "90th_percentile": 26.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 26.68, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.68, "10th_percentile": 26.68, "90th_percentile": 26.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 23.1, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 23.1, "10th_percentile": 23.1, "90th_percentile": 23.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 23.1, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 23.1, "10th_percentile": 23.1, "90th_percentile": 23.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 55.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 55.0, "10th_percentile": 55.0, "90th_percentile": 55.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 55.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 55.0, "10th_percentile": 55.0, "90th_percentile": 55.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 55.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 55.0, "10th_percentile": 55.0, "90th_percentile": 55.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 55.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 55.0, "10th_percentile": 55.0, "90th_percentile": 55.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 55.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 55.0, "10th_percentile": 55.0, "90th_percentile": 55.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Change of Bladder Tube", "code_information": [ { "code": "PX-36100946", "type": "CDM" }, { "code": "51710", "type": "CPT" }, { "code": "0761", "type": "RC" } ], "standard_charges": [ { "minimum": 1959.3, "maximum": 4665.0, "setting": "outpatient", "gross_charge": 4665.0, "discounted_cash": 3265.5, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4665.0, "10th_percentile": 4665.0, "90th_percentile": 4665.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4665.0, "10th_percentile": 4665.0, "90th_percentile": 4665.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4665.0, "10th_percentile": 4665.0, "90th_percentile": 4665.0, "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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2799.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 3032.25, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2799.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 2799.0, "10th_percentile": 2799.0, "90th_percentile": 2799.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2607.74, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2607.74, "10th_percentile": 2607.74, "90th_percentile": 2607.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2726.23, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2726.23, "10th_percentile": 2726.23, "90th_percentile": 2726.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1959.3, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1959.3, "10th_percentile": 1959.3, "90th_percentile": 1959.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1959.3, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1959.3, "10th_percentile": 1959.3, "90th_percentile": 1959.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3732.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 3732.0, "10th_percentile": 3732.0, "90th_percentile": 3732.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 3120.89, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3120.89, "10th_percentile": 3120.89, "90th_percentile": 3120.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 4058.55, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 4058.55, "10th_percentile": 4058.55, "90th_percentile": 4058.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2726.23, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2726.23, "10th_percentile": 2726.23, "90th_percentile": 2726.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH THE ALLIANCE", "standard_charge_dollar": 2535.43, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2535.43, "10th_percentile": 2535.43, "90th_percentile": 2535.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2938.95, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2938.95, "10th_percentile": 2938.95, "90th_percentile": 2938.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2192.55, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2192.55, "10th_percentile": 2192.55, "90th_percentile": 2192.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2332.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2332.5, "10th_percentile": 2332.5, "90th_percentile": 2332.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH DREYER - IPA", "standard_charge_dollar": 2799.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 2799.0, "10th_percentile": 2799.0, "90th_percentile": 2799.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2799.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2799.0, "10th_percentile": 2799.0, "90th_percentile": 2799.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2799.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4665.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4665.0, "10th_percentile": 4665.0, "90th_percentile": 4665.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4665.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4665.0, "10th_percentile": 4665.0, "90th_percentile": 4665.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4665.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4665.0, "10th_percentile": 4665.0, "90th_percentile": 4665.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4665.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4665.0, "10th_percentile": 4665.0, "90th_percentile": 4665.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4665.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4665.0, "10th_percentile": 4665.0, "90th_percentile": 4665.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Chemodenervation Trunk 6 or More Muscles", "code_information": [ { "code": "PX-76100012", "type": "CDM" }, { "code": "64647", "type": "CPT" }, { "code": "0361", "type": "RC" } ], "standard_charges": [ { "minimum": 1571.82, "maximum": 1751.98, "setting": "outpatient", "gross_charge": 2611.0, "discounted_cash": 1827.7, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1571.82, "standard_charge_percentage": 60.2, "standard_charge_algorithm": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1571.82, "10th_percentile": 1571.82, "90th_percentile": 1571.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1751.98, "standard_charge_percentage": 67.1, "standard_charge_algorithm": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1751.98, "10th_percentile": 1751.98, "90th_percentile": 1751.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "HB Chloride, Random Urine", "code_information": [ { "code": "PX-30105161", "type": "CDM" }, { "code": "82436", "type": "CPT" }, { "code": "0301", "type": "RC" } ], "standard_charges": [ { "minimum": 27.3, "maximum": 65.0, "setting": "outpatient", "gross_charge": 65.0, "discounted_cash": 45.5, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $65.00 @ 12.5% = $8.13 due to $0.00 Claim Price", "median_amount": 8.13, "10th_percentile": 8.13, "90th_percentile": 8.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $65.00 @ 12.5% = $8.13 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $65.00 @ 12.5% = $8.13 due to $0.00 Claim Price", "median_amount": 8.13, "10th_percentile": 8.13, "90th_percentile": 8.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $65.00 @ 12.5% = $8.13 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $65.00 @ 12.5% = $8.13 due to $0.00 Claim Price", "median_amount": 8.13, "10th_percentile": 8.13, "90th_percentile": 8.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $65.00 @ 12.5% = $8.13 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 27.3, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 27.3, "10th_percentile": 27.3, "90th_percentile": 27.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 27.3, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 27.3, "10th_percentile": 27.3, "90th_percentile": 27.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 39.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 39.0, "10th_percentile": 39.0, "90th_percentile": 39.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 39.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 39.0, "10th_percentile": 39.0, "90th_percentile": 39.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 39.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 39.0, "10th_percentile": 39.0, "90th_percentile": 39.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 30.55, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 30.55, "10th_percentile": 30.55, "90th_percentile": 30.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 40.95, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 40.95, "10th_percentile": 40.95, "90th_percentile": 40.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 35.33, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 35.33, "10th_percentile": 35.33, "90th_percentile": 35.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 32.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 32.5, "10th_percentile": 32.5, "90th_percentile": 32.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 37.99, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 37.99, "10th_percentile": 37.99, "90th_percentile": 37.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 39.91, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 39.91, "10th_percentile": 39.91, "90th_percentile": 39.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 52.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 52.0, "10th_percentile": 52.0, "90th_percentile": 52.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 56.55, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 56.55, "10th_percentile": 56.55, "90th_percentile": 56.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 42.25, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 42.25, "10th_percentile": 42.25, "90th_percentile": 42.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 43.49, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 43.49, "10th_percentile": 43.49, "90th_percentile": 43.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 42.25, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 42.25, "10th_percentile": 42.25, "90th_percentile": 42.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 42.25, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 42.25, "10th_percentile": 42.25, "90th_percentile": 42.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 39.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 39.0, "10th_percentile": 39.0, "90th_percentile": 39.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 39.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 39.0, "10th_percentile": 39.0, "90th_percentile": 39.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 39.91, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 39.91, "10th_percentile": 39.91, "90th_percentile": 39.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 37.99, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 37.99, "10th_percentile": 37.99, "90th_percentile": 37.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 36.34, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 36.34, "10th_percentile": 36.34, "90th_percentile": 36.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 35.43, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 35.43, "10th_percentile": 35.43, "90th_percentile": 35.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 35.43, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 35.43, "10th_percentile": 35.43, "90th_percentile": 35.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 35.43, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 35.43, "10th_percentile": 35.43, "90th_percentile": 35.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 65.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 65.0, "10th_percentile": 65.0, "90th_percentile": 65.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 65.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 65.0, "10th_percentile": 65.0, "90th_percentile": 65.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 65.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 65.0, "10th_percentile": 65.0, "90th_percentile": 65.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 65.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 65.0, "10th_percentile": 65.0, "90th_percentile": 65.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 65.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 65.0, "10th_percentile": 65.0, "90th_percentile": 65.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Closed Tx Nasal Bone Fx W/Mnpj W/Stabilization", "code_information": [ { "code": "PX-36100202", "type": "CDM" }, { "code": "21320", "type": "CPT" }, { "code": "0361", "type": "RC" } ], "standard_charges": [ { "minimum": 3259.83, "maximum": 3633.47, "setting": "outpatient", "gross_charge": 5415.0, "discounted_cash": 3790.5, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 3259.83, "standard_charge_percentage": 60.2, "standard_charge_algorithm": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3259.83, "10th_percentile": 3259.83, "90th_percentile": 3259.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 3633.47, "standard_charge_percentage": 67.1, "standard_charge_algorithm": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3633.47, "10th_percentile": 3633.47, "90th_percentile": 3633.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "HB Closed Tx Ulnar Fracture Proximal End W/O Manj", "code_information": [ { "code": "PX-76100727", "type": "CDM" }, { "code": "24670", "type": "CPT" }, { "code": "0761", "type": "RC" } ], "standard_charges": [ { "minimum": 456.54, "maximum": 1087.0, "setting": "outpatient", "gross_charge": 1087.0, "discounted_cash": 760.9, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1087.0, "10th_percentile": 1087.0, "90th_percentile": 1087.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1087.0, "10th_percentile": 1087.0, "90th_percentile": 1087.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1087.0, "10th_percentile": 1087.0, "90th_percentile": 1087.0, "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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 652.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 706.55, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 652.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 652.2, "10th_percentile": 652.2, "90th_percentile": 652.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 607.63, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 607.63, "10th_percentile": 607.63, "90th_percentile": 607.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 635.24, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 635.24, "10th_percentile": 635.24, "90th_percentile": 635.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 456.54, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 456.54, "10th_percentile": 456.54, "90th_percentile": 456.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 456.54, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 456.54, "10th_percentile": 456.54, "90th_percentile": 456.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 869.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 869.6, "10th_percentile": 869.6, "90th_percentile": 869.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 727.2, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.2, "10th_percentile": 727.2, "90th_percentile": 727.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 945.69, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 945.69, "10th_percentile": 945.69, "90th_percentile": 945.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 635.24, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 635.24, "10th_percentile": 635.24, "90th_percentile": 635.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH THE ALLIANCE", "standard_charge_dollar": 590.78, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 590.78, "10th_percentile": 590.78, "90th_percentile": 590.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 684.81, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 684.81, "10th_percentile": 684.81, "90th_percentile": 684.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 510.89, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 510.89, "10th_percentile": 510.89, "90th_percentile": 510.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 543.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 543.5, "10th_percentile": 543.5, "90th_percentile": 543.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH DREYER - IPA", "standard_charge_dollar": 652.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 652.2, "10th_percentile": 652.2, "90th_percentile": 652.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 652.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 652.2, "10th_percentile": 652.2, "90th_percentile": 652.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 652.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1087.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1087.0, "10th_percentile": 1087.0, "90th_percentile": 1087.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1087.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1087.0, "10th_percentile": 1087.0, "90th_percentile": 1087.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1087.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1087.0, "10th_percentile": 1087.0, "90th_percentile": 1087.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1087.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1087.0, "10th_percentile": 1087.0, "90th_percentile": 1087.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1087.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1087.0, "10th_percentile": 1087.0, "90th_percentile": 1087.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Closure of Split Wound Simple With Packing", "code_information": [ { "code": "PX-36100089", "type": "CDM" }, { "code": "12021", "type": "CPT" }, { "code": "0361", "type": "RC" } ], "standard_charges": [ { "minimum": 1455.03, "maximum": 1621.81, "setting": "outpatient", "gross_charge": 2417.0, "discounted_cash": 1691.9, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1455.03, "standard_charge_percentage": 60.2, "standard_charge_algorithm": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1455.03, "10th_percentile": 1455.03, "90th_percentile": 1455.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1621.81, "standard_charge_percentage": 67.1, "standard_charge_algorithm": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1621.81, "10th_percentile": 1621.81, "90th_percentile": 1621.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "HB Clsd Tx Clavicular Fracture W/Manipulation", "code_information": [ { "code": "PX-36000024", "type": "CDM" }, { "code": "23505", "type": "CPT" }, { "code": "0761", "type": "RC" } ], "standard_charges": [ { "minimum": 1953.84, "maximum": 4652.0, "setting": "outpatient", "gross_charge": 4652.0, "discounted_cash": 3256.4, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4652.0, "10th_percentile": 4652.0, "90th_percentile": 4652.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4652.0, "10th_percentile": 4652.0, "90th_percentile": 4652.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4652.0, "10th_percentile": 4652.0, "90th_percentile": 4652.0, "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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2791.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 3023.8, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2791.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 2791.2, "10th_percentile": 2791.2, "90th_percentile": 2791.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2600.47, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2600.47, "10th_percentile": 2600.47, "90th_percentile": 2600.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2718.63, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2718.63, "10th_percentile": 2718.63, "90th_percentile": 2718.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1953.84, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1953.84, "10th_percentile": 1953.84, "90th_percentile": 1953.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1953.84, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1953.84, "10th_percentile": 1953.84, "90th_percentile": 1953.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3721.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 3721.6, "10th_percentile": 3721.6, "90th_percentile": 3721.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 3112.19, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3112.19, "10th_percentile": 3112.19, "90th_percentile": 3112.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 4047.24, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 4047.24, "10th_percentile": 4047.24, "90th_percentile": 4047.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2718.63, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2718.63, "10th_percentile": 2718.63, "90th_percentile": 2718.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH THE ALLIANCE", "standard_charge_dollar": 2528.36, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2528.36, "10th_percentile": 2528.36, "90th_percentile": 2528.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2930.76, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2930.76, "10th_percentile": 2930.76, "90th_percentile": 2930.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2186.44, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2186.44, "10th_percentile": 2186.44, "90th_percentile": 2186.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2326.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2326.0, "10th_percentile": 2326.0, "90th_percentile": 2326.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH DREYER - IPA", "standard_charge_dollar": 2791.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 2791.2, "10th_percentile": 2791.2, "90th_percentile": 2791.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2791.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2791.2, "10th_percentile": 2791.2, "90th_percentile": 2791.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2791.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4652.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4652.0, "10th_percentile": 4652.0, "90th_percentile": 4652.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4652.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4652.0, "10th_percentile": 4652.0, "90th_percentile": 4652.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4652.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4652.0, "10th_percentile": 4652.0, "90th_percentile": 4652.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4652.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4652.0, "10th_percentile": 4652.0, "90th_percentile": 4652.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4652.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4652.0, "10th_percentile": 4652.0, "90th_percentile": 4652.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Cltx Dstl Fem Epiphysl Sep W/Manj W/WO Skin/Skel", "code_information": [ { "code": "PX-76100223", "type": "CDM" }, { "code": "27517", "type": "CPT" }, { "code": "0761", "type": "RC" } ], "standard_charges": [ { "minimum": 1759.8, "maximum": 4190.0, "setting": "outpatient", "gross_charge": 4190.0, "discounted_cash": 2933.0, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4190.0, "10th_percentile": 4190.0, "90th_percentile": 4190.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4190.0, "10th_percentile": 4190.0, "90th_percentile": 4190.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4190.0, "10th_percentile": 4190.0, "90th_percentile": 4190.0, "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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2514.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 2723.5, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2514.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 2514.0, "10th_percentile": 2514.0, "90th_percentile": 2514.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2342.21, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2342.21, "10th_percentile": 2342.21, "90th_percentile": 2342.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2448.64, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2448.64, "10th_percentile": 2448.64, "90th_percentile": 2448.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1759.8, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1759.8, "10th_percentile": 1759.8, "90th_percentile": 1759.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1759.8, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1759.8, "10th_percentile": 1759.8, "90th_percentile": 1759.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3352.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 3352.0, "10th_percentile": 3352.0, "90th_percentile": 3352.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 2803.11, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2803.11, "10th_percentile": 2803.11, "90th_percentile": 2803.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 3645.3, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 3645.3, "10th_percentile": 3645.3, "90th_percentile": 3645.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2448.64, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2448.64, "10th_percentile": 2448.64, "90th_percentile": 2448.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH THE ALLIANCE", "standard_charge_dollar": 2277.27, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2277.27, "10th_percentile": 2277.27, "90th_percentile": 2277.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2639.7, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2639.7, "10th_percentile": 2639.7, "90th_percentile": 2639.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1969.3, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1969.3, "10th_percentile": 1969.3, "90th_percentile": 1969.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2095.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2095.0, "10th_percentile": 2095.0, "90th_percentile": 2095.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH DREYER - IPA", "standard_charge_dollar": 2514.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 2514.0, "10th_percentile": 2514.0, "90th_percentile": 2514.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2514.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2514.0, "10th_percentile": 2514.0, "90th_percentile": 2514.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2514.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4190.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4190.0, "10th_percentile": 4190.0, "90th_percentile": 4190.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4190.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4190.0, "10th_percentile": 4190.0, "90th_percentile": 4190.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4190.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4190.0, "10th_percentile": 4190.0, "90th_percentile": 4190.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4190.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4190.0, "10th_percentile": 4190.0, "90th_percentile": 4190.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4190.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4190.0, "10th_percentile": 4190.0, "90th_percentile": 4190.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Cltx Phlngl Fx Prox/Middle Px/F/T W/O Manj Ea", "code_information": [ { "code": "PX-36100263", "type": "CDM" }, { "code": "26720", "type": "CPT" }, { "code": "0361", "type": "RC" } ], "standard_charges": [ { "minimum": 523.74, "maximum": 583.77, "setting": "outpatient", "gross_charge": 870.0, "discounted_cash": 609.0, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 523.74, "standard_charge_percentage": 60.2, "standard_charge_algorithm": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 523.74, "10th_percentile": 523.74, "90th_percentile": 523.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 583.77, "standard_charge_percentage": 67.1, "standard_charge_algorithm": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 583.77, "10th_percentile": 583.77, "90th_percentile": 583.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "HB Cmplx Rpr E/N/E/L 1.1-2.5 Cm", "code_information": [ { "code": "PX-36100113", "type": "CDM" }, { "code": "13151", "type": "CPT" }, { "code": "0361", "type": "RC" } ], "standard_charges": [ { "minimum": 1355.1, "maximum": 1510.42, "setting": "outpatient", "gross_charge": 2251.0, "discounted_cash": 1575.7, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1355.1, "standard_charge_percentage": 60.2, "standard_charge_algorithm": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1355.1, "10th_percentile": 1355.1, "90th_percentile": 1355.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1510.42, "standard_charge_percentage": 67.1, "standard_charge_algorithm": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1510.42, "10th_percentile": 1510.42, "90th_percentile": 1510.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "HB Cmv, Pcr", "code_information": [ { "code": "PX-30614675", "type": "CDM" }, { "code": "87496", "type": "CPT" }, { "code": "0306", "type": "RC" } ], "standard_charges": [ { "minimum": 154.56, "maximum": 368.0, "setting": "outpatient", "gross_charge": 368.0, "discounted_cash": 257.6, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $368.00 @ 12.5% = $46.00 due to $0.00 Claim Price", "median_amount": 46.0, "10th_percentile": 46.0, "90th_percentile": 46.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $368.00 @ 12.5% = $46.00 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $368.00 @ 12.5% = $46.00 due to $0.00 Claim Price", "median_amount": 46.0, "10th_percentile": 46.0, "90th_percentile": 46.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $368.00 @ 12.5% = $46.00 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $368.00 @ 12.5% = $46.00 due to $0.00 Claim Price", "median_amount": 46.0, "10th_percentile": 46.0, "90th_percentile": 46.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $368.00 @ 12.5% = $46.00 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 239.2, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 239.2, "10th_percentile": 239.2, "90th_percentile": 239.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 220.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 220.8, "10th_percentile": 220.8, "90th_percentile": 220.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 239.2, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 239.2, "10th_percentile": 239.2, "90th_percentile": 239.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 225.95, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 225.95, "10th_percentile": 225.95, "90th_percentile": 225.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 220.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 220.8, "10th_percentile": 220.8, "90th_percentile": 220.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 205.71, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 205.71, "10th_percentile": 205.71, "90th_percentile": 205.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 215.06, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 215.06, "10th_percentile": 215.06, "90th_percentile": 215.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 200.56, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 200.56, "10th_percentile": 200.56, "90th_percentile": 200.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 200.56, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 200.56, "10th_percentile": 200.56, "90th_percentile": 200.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 200.56, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 200.56, "10th_percentile": 200.56, "90th_percentile": 200.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 154.56, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 154.56, "10th_percentile": 154.56, "90th_percentile": 154.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 154.56, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 154.56, "10th_percentile": 154.56, "90th_percentile": 154.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 246.19, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 246.19, "10th_percentile": 246.19, "90th_percentile": 246.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 239.2, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 239.2, "10th_percentile": 239.2, "90th_percentile": 239.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 294.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 294.4, "10th_percentile": 294.4, "90th_percentile": 294.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 320.16, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 320.16, "10th_percentile": 320.16, "90th_percentile": 320.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 225.95, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 225.95, "10th_percentile": 225.95, "90th_percentile": 225.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 184.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 184.0, "10th_percentile": 184.0, "90th_percentile": 184.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 172.96, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 172.96, "10th_percentile": 172.96, "90th_percentile": 172.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 200.01, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 200.01, "10th_percentile": 200.01, "90th_percentile": 200.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 215.06, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 215.06, "10th_percentile": 215.06, "90th_percentile": 215.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 231.84, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 231.84, "10th_percentile": 231.84, "90th_percentile": 231.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 220.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 220.8, "10th_percentile": 220.8, "90th_percentile": 220.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 220.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 220.8, "10th_percentile": 220.8, "90th_percentile": 220.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 220.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 220.8, "10th_percentile": 220.8, "90th_percentile": 220.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 368.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 368.0, "10th_percentile": 368.0, "90th_percentile": 368.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 368.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 368.0, "10th_percentile": 368.0, "90th_percentile": 368.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 368.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 368.0, "10th_percentile": 368.0, "90th_percentile": 368.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 368.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 368.0, "10th_percentile": 368.0, "90th_percentile": 368.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 368.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 368.0, "10th_percentile": 368.0, "90th_percentile": 368.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Cold Agglutinin Screen", "code_information": [ { "code": "PX-30208690", "type": "CDM" }, { "code": "86156", "type": "CPT" }, { "code": "0302", "type": "RC" } ], "standard_charges": [ { "minimum": 49.14, "maximum": 117.0, "setting": "outpatient", "gross_charge": 117.0, "discounted_cash": 81.9, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $117.00 @ 12.5% = $14.63 due to $0.00 Claim Price", "median_amount": 14.63, "10th_percentile": 14.63, "90th_percentile": 14.63, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $117.00 @ 12.5% = $14.63 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $117.00 @ 12.5% = $14.63 due to $0.00 Claim Price", "median_amount": 14.63, "10th_percentile": 14.63, "90th_percentile": 14.63, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $117.00 @ 12.5% = $14.63 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $117.00 @ 12.5% = $14.63 due to $0.00 Claim Price", "median_amount": 14.63, "10th_percentile": 14.63, "90th_percentile": 14.63, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $117.00 @ 12.5% = $14.63 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 76.05, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 76.05, "10th_percentile": 76.05, "90th_percentile": 76.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 70.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 70.2, "10th_percentile": 70.2, "90th_percentile": 70.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 76.05, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 76.05, "10th_percentile": 76.05, "90th_percentile": 76.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 71.84, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 71.84, "10th_percentile": 71.84, "90th_percentile": 71.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 70.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 70.2, "10th_percentile": 70.2, "90th_percentile": 70.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 65.4, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 65.4, "10th_percentile": 65.4, "90th_percentile": 65.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 68.37, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.37, "10th_percentile": 68.37, "90th_percentile": 68.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 63.77, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 63.77, "10th_percentile": 63.77, "90th_percentile": 63.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 63.77, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 63.77, "10th_percentile": 63.77, "90th_percentile": 63.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 63.77, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 63.77, "10th_percentile": 63.77, "90th_percentile": 63.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 49.14, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 49.14, "10th_percentile": 49.14, "90th_percentile": 49.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 49.14, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 49.14, "10th_percentile": 49.14, "90th_percentile": 49.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 78.27, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 78.27, "10th_percentile": 78.27, "90th_percentile": 78.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 76.05, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 76.05, "10th_percentile": 76.05, "90th_percentile": 76.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 101.79, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 101.79, "10th_percentile": 101.79, "90th_percentile": 101.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 93.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 93.6, "10th_percentile": 93.6, "90th_percentile": 93.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 71.84, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 71.84, "10th_percentile": 71.84, "90th_percentile": 71.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 54.99, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 54.99, "10th_percentile": 54.99, "90th_percentile": 54.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 73.71, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 73.71, "10th_percentile": 73.71, "90th_percentile": 73.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 63.59, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 63.59, "10th_percentile": 63.59, "90th_percentile": 63.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 58.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 58.5, "10th_percentile": 58.5, "90th_percentile": 58.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 68.37, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.37, "10th_percentile": 68.37, "90th_percentile": 68.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 70.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 70.2, "10th_percentile": 70.2, "90th_percentile": 70.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 70.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 70.2, "10th_percentile": 70.2, "90th_percentile": 70.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 70.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 70.2, "10th_percentile": 70.2, "90th_percentile": 70.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 117.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 117.0, "10th_percentile": 117.0, "90th_percentile": 117.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 117.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 117.0, "10th_percentile": 117.0, "90th_percentile": 117.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 117.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 117.0, "10th_percentile": 117.0, "90th_percentile": 117.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 117.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 117.0, "10th_percentile": 117.0, "90th_percentile": 117.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 117.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 117.0, "10th_percentile": 117.0, "90th_percentile": 117.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Colonoscopy W Endoscopic Full-Thickness Resection (Eftr) - Unlisted", "code_information": [ { "code": "PX-75000372", "type": "CDM" }, { "code": "45399", "type": "CPT" }, { "code": "0750", "type": "RC" } ], "standard_charges": [ { "minimum": 1029.42, "maximum": 2451.0, "setting": "outpatient", "gross_charge": 2451.0, "discounted_cash": 1715.7, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,451.00 @ 12.5% = $306.38 due to $0.00 Claim Price", "median_amount": 306.38, "10th_percentile": 306.38, "90th_percentile": 306.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,451.00 @ 12.5% = $306.38 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,451.00 @ 12.5% = $306.38 due to $0.00 Claim Price", "median_amount": 306.38, "10th_percentile": 306.38, "90th_percentile": 306.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,451.00 @ 12.5% = $306.38 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,451.00 @ 12.5% = $306.38 due to $0.00 Claim Price", "median_amount": 306.38, "10th_percentile": 306.38, "90th_percentile": 306.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,451.00 @ 12.5% = $306.38 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1470.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 1593.15, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 1593.15, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 1593.15, "10th_percentile": 1593.15, "90th_percentile": 1593.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 1504.91, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 1504.91, "10th_percentile": 1504.91, "90th_percentile": 1504.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 1470.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1470.6, "10th_percentile": 1470.6, "90th_percentile": 1470.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1370.11, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 1370.11, "10th_percentile": 1370.11, "90th_percentile": 1370.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1432.36, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1432.36, "10th_percentile": 1432.36, "90th_percentile": 1432.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1335.8, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 1335.8, "10th_percentile": 1335.8, "90th_percentile": 1335.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1335.8, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 1335.8, "10th_percentile": 1335.8, "90th_percentile": 1335.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1335.8, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 1335.8, "10th_percentile": 1335.8, "90th_percentile": 1335.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1029.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1029.42, "10th_percentile": 1029.42, "90th_percentile": 1029.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1029.42, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1029.42, "10th_percentile": 1029.42, "90th_percentile": 1029.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 1475.5, "standard_charge_percentage": 60.2, "standard_charge_algorithm": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1475.5, "10th_percentile": 1475.5, "90th_percentile": 1475.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 1644.62, "standard_charge_percentage": 67.1, "standard_charge_algorithm": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1644.62, "10th_percentile": 1644.62, "90th_percentile": 1644.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 1593.15, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 1593.15, "10th_percentile": 1593.15, "90th_percentile": 1593.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 1504.91, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 1504.91, "10th_percentile": 1504.91, "90th_percentile": 1504.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 1225.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 1225.5, "10th_percentile": 1225.5, "90th_percentile": 1225.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 1639.72, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1639.72, "10th_percentile": 1639.72, "90th_percentile": 1639.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 2132.37, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 2132.37, "10th_percentile": 2132.37, "90th_percentile": 2132.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 1960.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 1960.8, "10th_percentile": 1960.8, "90th_percentile": 1960.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 1432.36, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1432.36, "10th_percentile": 1432.36, "90th_percentile": 1432.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 1544.13, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 1544.13, "10th_percentile": 1544.13, "90th_percentile": 1544.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 1151.97, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 1151.97, "10th_percentile": 1151.97, "90th_percentile": 1151.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 1332.12, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 1332.12, "10th_percentile": 1332.12, "90th_percentile": 1332.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 1470.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 1470.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1470.6, "10th_percentile": 1470.6, "90th_percentile": 1470.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 1470.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 1470.6, "10th_percentile": 1470.6, "90th_percentile": 1470.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2451.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2451.0, "10th_percentile": 2451.0, "90th_percentile": 2451.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2451.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2451.0, "10th_percentile": 2451.0, "90th_percentile": 2451.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2451.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2451.0, "10th_percentile": 2451.0, "90th_percentile": 2451.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2451.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2451.0, "10th_percentile": 2451.0, "90th_percentile": 2451.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2451.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2451.0, "10th_percentile": 2451.0, "90th_percentile": 2451.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Colonoscopy W/Biopsy Single/Multiple", "code_information": [ { "code": "PX-75000103", "type": "CDM" }, { "code": "45380", "type": "CPT" }, { "code": "0750", "type": "RC" } ], "standard_charges": [ { "minimum": 2456.58, "maximum": 5849.0, "setting": "outpatient", "gross_charge": 5849.0, "discounted_cash": 4094.3, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_algorithm": "No contract line matched", "median_amount": 5849.0, "10th_percentile": 5849.0, "90th_percentile": 5849.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH AETNA", "standard_charge_algorithm": "No contract line matched", "median_amount": 5849.0, "10th_percentile": 5849.0, "90th_percentile": 5849.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,849.00 @ 12.5% = $731.13 due to $0.00 Claim Price", "median_amount": 731.13, "10th_percentile": 731.13, "90th_percentile": 731.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,849.00 @ 12.5% = $731.13 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,849.00 @ 12.5% = $731.13 due to $0.00 Claim Price", "median_amount": 731.13, "10th_percentile": 731.13, "90th_percentile": 731.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,849.00 @ 12.5% = $731.13 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,849.00 @ 12.5% = $731.13 due to $0.00 Claim Price", "median_amount": 731.13, "10th_percentile": 731.13, "90th_percentile": 731.13, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,849.00 @ 12.5% = $731.13 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3509.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 3801.85, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 3591.29, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3591.29, "10th_percentile": 3591.29, "90th_percentile": 3591.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 3509.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3509.4, "10th_percentile": 3509.4, "90th_percentile": 3509.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3269.59, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 3269.59, "10th_percentile": 3269.59, "90th_percentile": 3269.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3418.16, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3418.16, "10th_percentile": 3418.16, "90th_percentile": 3418.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 3187.71, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3187.71, "10th_percentile": 3187.71, "90th_percentile": 3187.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 3187.71, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3187.71, "10th_percentile": 3187.71, "90th_percentile": 3187.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3187.71, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 3187.71, "10th_percentile": 3187.71, "90th_percentile": 3187.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2456.58, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2456.58, "10th_percentile": 2456.58, "90th_percentile": 2456.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2456.58, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2456.58, "10th_percentile": 2456.58, "90th_percentile": 2456.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 3521.1, "standard_charge_percentage": 60.2, "standard_charge_algorithm": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3521.1, "10th_percentile": 3521.1, "90th_percentile": 3521.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 3924.68, "standard_charge_percentage": 67.1, "standard_charge_algorithm": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 3591.29, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 3591.29, "10th_percentile": 3591.29, "90th_percentile": 3591.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2924.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2924.5, "10th_percentile": 2924.5, "90th_percentile": 2924.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 3912.98, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3912.98, "10th_percentile": 3912.98, "90th_percentile": 3912.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 5088.63, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 5088.63, "10th_percentile": 5088.63, "90th_percentile": 5088.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 4679.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 4679.2, "10th_percentile": 4679.2, "90th_percentile": 4679.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 3418.16, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3418.16, "10th_percentile": 3418.16, "90th_percentile": 3418.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 3684.87, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 3684.87, "10th_percentile": 3684.87, "90th_percentile": 3684.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2749.03, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2749.03, "10th_percentile": 2749.03, "90th_percentile": 2749.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 3178.93, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 3178.93, "10th_percentile": 3178.93, "90th_percentile": 3178.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3509.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 3509.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3509.4, "10th_percentile": 3509.4, "90th_percentile": 3509.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 3509.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3509.4, "10th_percentile": 3509.4, "90th_percentile": 3509.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5849.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5849.0, "10th_percentile": 5849.0, "90th_percentile": 5849.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5849.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5849.0, "10th_percentile": 5849.0, "90th_percentile": 5849.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5849.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5849.0, "10th_percentile": 5849.0, "90th_percentile": 5849.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5849.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5849.0, "10th_percentile": 5849.0, "90th_percentile": 5849.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5849.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5849.0, "10th_percentile": 5849.0, "90th_percentile": 5849.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Complement: C3", "code_information": [ { "code": "PX-30209155", "type": "CDM" }, { "code": "86160", "type": "CPT" }, { "code": "0302", "type": "RC" } ], "standard_charges": [ { "minimum": 58.8, "maximum": 140.0, "setting": "outpatient", "gross_charge": 140.0, "discounted_cash": 98.0, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_algorithm": "No contract line matched", "median_amount": 140.0, "10th_percentile": 140.0, "90th_percentile": 140.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH AETNA", "standard_charge_algorithm": "No contract line matched", "median_amount": 140.0, "10th_percentile": 140.0, "90th_percentile": 140.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $140.00 @ 12.5% = $17.50 due to $0.00 Claim Price", "median_amount": 17.5, "10th_percentile": 17.5, "90th_percentile": 17.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $140.00 @ 12.5% = $17.50 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $140.00 @ 12.5% = $17.50 due to $0.00 Claim Price", "median_amount": 17.5, "10th_percentile": 17.5, "90th_percentile": 17.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $140.00 @ 12.5% = $17.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $140.00 @ 12.5% = $17.50 due to $0.00 Claim Price", "median_amount": 17.5, "10th_percentile": 17.5, "90th_percentile": 17.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $140.00 @ 12.5% = $17.50 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 91.0, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 91.0, "10th_percentile": 91.0, "90th_percentile": 91.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 84.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 84.0, "10th_percentile": 84.0, "90th_percentile": 84.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 91.0, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 91.0, "10th_percentile": 91.0, "90th_percentile": 91.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 85.96, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 85.96, "10th_percentile": 85.96, "90th_percentile": 85.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 84.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 84.0, "10th_percentile": 84.0, "90th_percentile": 84.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 78.26, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 78.26, "10th_percentile": 78.26, "90th_percentile": 78.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 81.82, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 81.82, "10th_percentile": 81.82, "90th_percentile": 81.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 76.3, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 76.3, "10th_percentile": 76.3, "90th_percentile": 76.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 76.3, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 76.3, "10th_percentile": 76.3, "90th_percentile": 76.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 76.3, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 76.3, "10th_percentile": 76.3, "90th_percentile": 76.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 58.8, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 58.8, "10th_percentile": 58.8, "90th_percentile": 58.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 58.8, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 58.8, "10th_percentile": 58.8, "90th_percentile": 58.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 93.66, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 93.66, "10th_percentile": 93.66, "90th_percentile": 93.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 91.0, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 91.0, "10th_percentile": 91.0, "90th_percentile": 91.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 121.8, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 121.8, "10th_percentile": 121.8, "90th_percentile": 121.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 112.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 112.0, "10th_percentile": 112.0, "90th_percentile": 112.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 85.96, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 85.96, "10th_percentile": 85.96, "90th_percentile": 85.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 65.8, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 65.8, "10th_percentile": 65.8, "90th_percentile": 65.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 88.2, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 88.2, "10th_percentile": 88.2, "90th_percentile": 88.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 76.09, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 76.09, "10th_percentile": 76.09, "90th_percentile": 76.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 70.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 70.0, "10th_percentile": 70.0, "90th_percentile": 70.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 81.82, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 81.82, "10th_percentile": 81.82, "90th_percentile": 81.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 84.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 84.0, "10th_percentile": 84.0, "90th_percentile": 84.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 84.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 84.0, "10th_percentile": 84.0, "90th_percentile": 84.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 84.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 84.0, "10th_percentile": 84.0, "90th_percentile": 84.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 140.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 140.0, "10th_percentile": 140.0, "90th_percentile": 140.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 140.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 140.0, "10th_percentile": 140.0, "90th_percentile": 140.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 140.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 140.0, "10th_percentile": 140.0, "90th_percentile": 140.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 140.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 140.0, "10th_percentile": 140.0, "90th_percentile": 140.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 140.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 140.0, "10th_percentile": 140.0, "90th_percentile": 140.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Comprehensive Community Support Services Group, per 15 Minutes", "code_information": [ { "code": "PX-91900002", "type": "CDM" }, { "code": "H2015", "type": "CPT" }, { "code": "0919", "type": "RC" } ], "standard_charges": [ { "minimum": 31.5, "maximum": 75.0, "setting": "outpatient", "gross_charge": 75.0, "discounted_cash": 52.5, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_algorithm": "No contract line matched", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $75.00 @ 12.5% = $9.38 due to $0.00 Claim Price", "median_amount": 9.38, "10th_percentile": 9.38, "90th_percentile": 9.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $75.00 @ 12.5% = $9.38 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $75.00 @ 12.5% = $9.38 due to $0.00 Claim Price", "median_amount": 9.38, "10th_percentile": 9.38, "90th_percentile": 9.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $75.00 @ 12.5% = $9.38 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $75.00 @ 12.5% = $9.38 due to $0.00 Claim Price", "median_amount": 9.38, "10th_percentile": 9.38, "90th_percentile": 9.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $75.00 @ 12.5% = $9.38 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 48.75, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 48.75, "10th_percentile": 48.75, "90th_percentile": 48.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 45.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 48.75, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 48.75, "10th_percentile": 48.75, "90th_percentile": 48.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 46.05, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 46.05, "10th_percentile": 46.05, "90th_percentile": 46.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 45.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 41.93, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 41.93, "10th_percentile": 41.93, "90th_percentile": 41.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 43.83, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 43.83, "10th_percentile": 43.83, "90th_percentile": 43.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 40.88, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 40.88, "10th_percentile": 40.88, "90th_percentile": 40.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 40.88, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 40.88, "10th_percentile": 40.88, "90th_percentile": 40.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 40.88, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 40.88, "10th_percentile": 40.88, "90th_percentile": 40.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 31.5, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 31.5, "10th_percentile": 31.5, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 31.5, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 31.5, "10th_percentile": 31.5, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 48.75, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 48.75, "10th_percentile": 48.75, "90th_percentile": 48.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 46.05, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 46.05, "10th_percentile": 46.05, "90th_percentile": 46.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 37.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 37.5, "10th_percentile": 37.5, "90th_percentile": 37.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 50.18, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 50.18, "10th_percentile": 50.18, "90th_percentile": 50.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 65.25, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 65.25, "10th_percentile": 65.25, "90th_percentile": 65.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 60.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 60.0, "10th_percentile": 60.0, "90th_percentile": 60.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 43.83, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 43.83, "10th_percentile": 43.83, "90th_percentile": 43.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 47.25, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 47.25, "10th_percentile": 47.25, "90th_percentile": 47.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 35.25, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 35.25, "10th_percentile": 35.25, "90th_percentile": 35.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 40.76, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 40.76, "10th_percentile": 40.76, "90th_percentile": 40.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 45.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 45.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 45.0, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 75.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 75.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 75.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 75.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 75.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 75.0, "10th_percentile": 75.0, "90th_percentile": 75.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Continuing Care Group Psychotherapy", "code_information": [ { "code": "PX-91500011", "type": "CDM" }, { "code": "90853", "type": "CPT" }, { "code": "0915", "type": "RC" } ], "standard_charges": [ { "minimum": 49.56, "maximum": 118.0, "setting": "outpatient", "gross_charge": 118.0, "discounted_cash": 82.6, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_algorithm": "No contract line matched", "median_amount": 118.0, "10th_percentile": 118.0, "90th_percentile": 118.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 118.0, "10th_percentile": 118.0, "90th_percentile": 118.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $118.00 @ 12.5% = $14.75 due to $0.00 Claim Price", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $118.00 @ 12.5% = $14.75 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $118.00 @ 12.5% = $14.75 due to $0.00 Claim Price", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $118.00 @ 12.5% = $14.75 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $118.00 @ 12.5% = $14.75 due to $0.00 Claim Price", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $118.00 @ 12.5% = $14.75 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 76.7, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 76.7, "10th_percentile": 76.7, "90th_percentile": 76.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 70.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 70.8, "10th_percentile": 70.8, "90th_percentile": 70.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 72.45, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 72.45, "10th_percentile": 72.45, "90th_percentile": 72.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 70.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 70.8, "10th_percentile": 70.8, "90th_percentile": 70.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 65.96, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 65.96, "10th_percentile": 65.96, "90th_percentile": 65.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 68.96, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.96, "10th_percentile": 68.96, "90th_percentile": 68.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 64.31, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 64.31, "10th_percentile": 64.31, "90th_percentile": 64.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 64.31, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 64.31, "10th_percentile": 64.31, "90th_percentile": 64.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 64.31, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 64.31, "10th_percentile": 64.31, "90th_percentile": 64.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 49.56, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 49.56, "10th_percentile": 49.56, "90th_percentile": 49.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 49.56, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 49.56, "10th_percentile": 49.56, "90th_percentile": 49.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 72.45, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 72.45, "10th_percentile": 72.45, "90th_percentile": 72.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 59.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 59.0, "10th_percentile": 59.0, "90th_percentile": 59.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 78.94, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 78.94, "10th_percentile": 78.94, "90th_percentile": 78.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 102.66, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 102.66, "10th_percentile": 102.66, "90th_percentile": 102.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 94.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 94.4, "10th_percentile": 94.4, "90th_percentile": 94.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 68.96, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.96, "10th_percentile": 68.96, "90th_percentile": 68.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 74.34, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 74.34, "10th_percentile": 74.34, "90th_percentile": 74.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 55.46, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 55.46, "10th_percentile": 55.46, "90th_percentile": 55.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 64.13, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 64.13, "10th_percentile": 64.13, "90th_percentile": 64.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 70.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 70.8, "10th_percentile": 70.8, "90th_percentile": 70.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 70.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 70.8, "10th_percentile": 70.8, "90th_percentile": 70.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 70.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 70.8, "10th_percentile": 70.8, "90th_percentile": 70.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 118.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 118.0, "10th_percentile": 118.0, "90th_percentile": 118.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 118.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 118.0, "10th_percentile": 118.0, "90th_percentile": 118.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 118.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 118.0, "10th_percentile": 118.0, "90th_percentile": 118.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 118.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 118.0, "10th_percentile": 118.0, "90th_percentile": 118.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 118.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 118.0, "10th_percentile": 118.0, "90th_percentile": 118.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Control Throat Bleeding Simple", "code_information": [ { "code": "PX-36100560", "type": "CDM" }, { "code": "42960", "type": "CPT" }, { "code": "0761", "type": "RC" } ], "standard_charges": [ { "minimum": 1941.66, "maximum": 4623.0, "setting": "outpatient", "gross_charge": 4623.0, "discounted_cash": 3236.1, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4623.0, "10th_percentile": 4623.0, "90th_percentile": 4623.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4623.0, "10th_percentile": 4623.0, "90th_percentile": 4623.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4623.0, "10th_percentile": 4623.0, "90th_percentile": 4623.0, "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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2773.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 3004.95, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 2773.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 2773.8, "10th_percentile": 2773.8, "90th_percentile": 2773.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2584.26, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2584.26, "10th_percentile": 2584.26, "90th_percentile": 2584.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2701.68, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2701.68, "10th_percentile": 2701.68, "90th_percentile": 2701.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1941.66, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1941.66, "10th_percentile": 1941.66, "90th_percentile": 1941.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 1941.66, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 1941.66, "10th_percentile": 1941.66, "90th_percentile": 1941.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 3698.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 3698.4, "10th_percentile": 3698.4, "90th_percentile": 3698.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 3092.79, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3092.79, "10th_percentile": 3092.79, "90th_percentile": 3092.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 4022.01, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 4022.01, "10th_percentile": 4022.01, "90th_percentile": 4022.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2701.68, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2701.68, "10th_percentile": 2701.68, "90th_percentile": 2701.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH THE ALLIANCE", "standard_charge_dollar": 2512.6, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2512.6, "10th_percentile": 2512.6, "90th_percentile": 2512.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 2912.49, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 2912.49, "10th_percentile": 2912.49, "90th_percentile": 2912.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2172.81, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2172.81, "10th_percentile": 2172.81, "90th_percentile": 2172.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2311.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2311.5, "10th_percentile": 2311.5, "90th_percentile": 2311.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH DREYER - IPA", "standard_charge_dollar": 2773.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 2773.8, "10th_percentile": 2773.8, "90th_percentile": 2773.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 2773.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2773.8, "10th_percentile": 2773.8, "90th_percentile": 2773.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 2773.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4623.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4623.0, "10th_percentile": 4623.0, "90th_percentile": 4623.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4623.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4623.0, "10th_percentile": 4623.0, "90th_percentile": 4623.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4623.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4623.0, "10th_percentile": 4623.0, "90th_percentile": 4623.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4623.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4623.0, "10th_percentile": 4623.0, "90th_percentile": 4623.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4623.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4623.0, "10th_percentile": 4623.0, "90th_percentile": 4623.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Conz of Cervix W/Scope Leep", "code_information": [ { "code": "PX-36100658", "type": "CDM" }, { "code": "57461", "type": "CPT" }, { "code": "0761", "type": "RC" } ], "standard_charges": [ { "minimum": 2102.94, "maximum": 5007.0, "setting": "outpatient", "gross_charge": 5007.0, "discounted_cash": 3504.9, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5007.0, "10th_percentile": 5007.0, "90th_percentile": 5007.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5007.0, "10th_percentile": 5007.0, "90th_percentile": 5007.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5007.0, "10th_percentile": 5007.0, "90th_percentile": 5007.0, "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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3004.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 3254.55, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 3004.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3004.2, "10th_percentile": 3004.2, "90th_percentile": 3004.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2798.91, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 2798.91, "10th_percentile": 2798.91, "90th_percentile": 2798.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2926.09, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2926.09, "10th_percentile": 2926.09, "90th_percentile": 2926.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2102.94, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2102.94, "10th_percentile": 2102.94, "90th_percentile": 2102.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 2102.94, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 2102.94, "10th_percentile": 2102.94, "90th_percentile": 2102.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 4005.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 4005.6, "10th_percentile": 4005.6, "90th_percentile": 4005.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 3349.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3349.68, "10th_percentile": 3349.68, "90th_percentile": 3349.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 4356.09, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 4356.09, "10th_percentile": 4356.09, "90th_percentile": 4356.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 2926.09, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2926.09, "10th_percentile": 2926.09, "90th_percentile": 2926.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH THE ALLIANCE", "standard_charge_dollar": 2721.3, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 2721.3, "10th_percentile": 2721.3, "90th_percentile": 2721.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 3154.41, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 3154.41, "10th_percentile": 3154.41, "90th_percentile": 3154.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 2353.29, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 2353.29, "10th_percentile": 2353.29, "90th_percentile": 2353.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 2503.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 2503.5, "10th_percentile": 2503.5, "90th_percentile": 2503.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH DREYER - IPA", "standard_charge_dollar": 3004.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 3004.2, "10th_percentile": 3004.2, "90th_percentile": 3004.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 3004.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3004.2, "10th_percentile": 3004.2, "90th_percentile": 3004.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 3004.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5007.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5007.0, "10th_percentile": 5007.0, "90th_percentile": 5007.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5007.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5007.0, "10th_percentile": 5007.0, "90th_percentile": 5007.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5007.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5007.0, "10th_percentile": 5007.0, "90th_percentile": 5007.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5007.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5007.0, "10th_percentile": 5007.0, "90th_percentile": 5007.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5007.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5007.0, "10th_percentile": 5007.0, "90th_percentile": 5007.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Coronary Artery Angio S&I", "code_information": [ { "code": "PX-48100072", "type": "CDM" }, { "code": "93454", "type": "CPT" }, { "code": "0481", "type": "RC" } ], "standard_charges": [ { "minimum": 8881.32, "maximum": 21146.0, "setting": "outpatient", "gross_charge": 21146.0, "discounted_cash": 14802.2, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $21,146.00 @ 12.5% = $2,643.25 due to $0.00 Claim Price", "median_amount": 2643.25, "10th_percentile": 2643.25, "90th_percentile": 2643.25, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $21,146.00 @ 12.5% = $2,643.25 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $21,146.00 @ 12.5% = $2,643.25 due to $0.00 Claim Price", "median_amount": 2643.25, "10th_percentile": 2643.25, "90th_percentile": 2643.25, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $21,146.00 @ 12.5% = $2,643.25 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $21,146.00 @ 12.5% = $2,643.25 due to $0.00 Claim Price", "median_amount": 2643.25, "10th_percentile": 2643.25, "90th_percentile": 2643.25, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $21,146.00 @ 12.5% = $2,643.25 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 12687.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 13744.9, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 12983.64, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "OP Surgery. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 12983.64, "10th_percentile": 12983.64, "90th_percentile": 12983.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 11524.57, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "OP Surgery. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 11524.57, "10th_percentile": 11524.57, "90th_percentile": 11524.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 11524.57, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "OP Surgery. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 11524.57, "10th_percentile": 11524.57, "90th_percentile": 11524.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 11524.57, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "OP Surgery. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 11524.57, "10th_percentile": 11524.57, "90th_percentile": 11524.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 12687.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 12687.6, "10th_percentile": 12687.6, "90th_percentile": 12687.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 11820.61, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 11820.61, "10th_percentile": 11820.61, "90th_percentile": 11820.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 12357.72, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12357.72, "10th_percentile": 12357.72, "90th_percentile": 12357.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 8881.32, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 8881.32, "10th_percentile": 8881.32, "90th_percentile": 8881.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 8881.32, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 8881.32, "10th_percentile": 8881.32, "90th_percentile": 8881.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 12983.64, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "OP Surgery. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 12983.64, "10th_percentile": 12983.64, "90th_percentile": 12983.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 12729.89, "standard_charge_percentage": 60.2, "standard_charge_algorithm": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12729.89, "10th_percentile": 12729.89, "90th_percentile": 12729.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 60.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_dollar": 14188.97, "standard_charge_percentage": 67.1, "standard_charge_algorithm": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14188.97, "10th_percentile": 14188.97, "90th_percentile": 14188.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Surgery; 67.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 10573.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 10573.0, "10th_percentile": 10573.0, "90th_percentile": 10573.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 14146.67, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14146.67, "10th_percentile": 14146.67, "90th_percentile": 14146.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 18397.02, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 18397.02, "10th_percentile": 18397.02, "90th_percentile": 18397.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 16916.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 16916.8, "10th_percentile": 16916.8, "90th_percentile": 16916.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 12357.72, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12357.72, "10th_percentile": 12357.72, "90th_percentile": 12357.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 13321.98, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 13321.98, "10th_percentile": 13321.98, "90th_percentile": 13321.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 9938.62, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 9938.62, "10th_percentile": 9938.62, "90th_percentile": 9938.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 11492.85, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 11492.85, "10th_percentile": 11492.85, "90th_percentile": 11492.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 12687.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 12687.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12687.6, "10th_percentile": 12687.6, "90th_percentile": 12687.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 12687.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 12687.6, "10th_percentile": 12687.6, "90th_percentile": 12687.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 21146.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 21146.0, "10th_percentile": 21146.0, "90th_percentile": 21146.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 21146.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 21146.0, "10th_percentile": 21146.0, "90th_percentile": 21146.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 21146.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 21146.0, "10th_percentile": 21146.0, "90th_percentile": 21146.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 21146.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 21146.0, "10th_percentile": 21146.0, "90th_percentile": 21146.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 21146.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 21146.0, "10th_percentile": 21146.0, "90th_percentile": 21146.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Cpm Knee Pad", "code_information": [ { "code": "PX-27105018", "type": "CDM" }, { "code": "27105018", "type": "LOCAL" }, { "code": "0271", "type": "RC" } ], "standard_charges": [ { "minimum": 55.86, "maximum": 133.0, "setting": "outpatient", "gross_charge": 133.0, "discounted_cash": 93.1, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 133.0, "10th_percentile": 133.0, "90th_percentile": 133.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 133.0, "10th_percentile": 133.0, "90th_percentile": 133.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 133.0, "10th_percentile": 133.0, "90th_percentile": 133.0, "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": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 86.45, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 86.45, "10th_percentile": 86.45, "90th_percentile": 86.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 79.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 79.8, "10th_percentile": 79.8, "90th_percentile": 79.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 76.71, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 76.71, "10th_percentile": 76.71, "90th_percentile": 76.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 67.78, "standard_charge_percentage": 50.96, "standard_charge_algorithm": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges.", "median_amount": 67.78, "10th_percentile": 67.78, "90th_percentile": 67.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 50.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 50.96% OF CHARGES; Note: Paid 50.96% of billed, which is the lesser of contractual rate and 50.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 86.45, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 86.45, "10th_percentile": 86.45, "90th_percentile": 86.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 74.35, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 74.35, "10th_percentile": 74.35, "90th_percentile": 74.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 79.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 79.8, "10th_percentile": 79.8, "90th_percentile": 79.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 77.73, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 77.73, "10th_percentile": 77.73, "90th_percentile": 77.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 64.54, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 64.54, "10th_percentile": 64.54, "90th_percentile": 64.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 64.54, "standard_charge_percentage": 48.53, "standard_charge_algorithm": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges.", "median_amount": 64.54, "10th_percentile": 64.54, "90th_percentile": 64.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 48.53% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 48.53% OF CHARGES; Note: Paid 48.53% of billed, which is the lesser of contractual rate and 48.53% of charges." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 79.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 79.8, "10th_percentile": 79.8, "90th_percentile": 79.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 79.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 79.8, "10th_percentile": 79.8, "90th_percentile": 79.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 79.8, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 79.8, "10th_percentile": 79.8, "90th_percentile": 79.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 83.79, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 83.79, "10th_percentile": 83.79, "90th_percentile": 83.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 62.51, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 62.51, "10th_percentile": 62.51, "90th_percentile": 62.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 86.45, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 86.45, "10th_percentile": 86.45, "90th_percentile": 86.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 72.29, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 72.29, "10th_percentile": 72.29, "90th_percentile": 72.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 115.71, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 115.71, "10th_percentile": 115.71, "90th_percentile": 115.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 88.98, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 88.98, "10th_percentile": 88.98, "90th_percentile": 88.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS HMO", "standard_charge_dollar": 77.73, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 77.73, "10th_percentile": 77.73, "90th_percentile": 77.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH PHCS", "standard_charge_dollar": 106.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 106.4, "10th_percentile": 106.4, "90th_percentile": 106.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 76.71, "standard_charge_percentage": 57.68, "standard_charge_algorithm": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges.", "median_amount": 76.71, "10th_percentile": 76.71, "90th_percentile": 76.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 57.68% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 57.68% OF CHARGES; Note: Paid 57.68% of billed, which is the lesser of contractual rate and 57.68% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 66.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 66.5, "10th_percentile": 66.5, "90th_percentile": 66.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "MRH UHC ALL OTHER", "standard_charge_dollar": 64.64, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 64.64, "10th_percentile": 64.64, "90th_percentile": 64.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_dollar": 64.51, "standard_charge_percentage": 48.5, "standard_charge_algorithm": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "Table 5 Services; 48.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 55.86, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 55.86, "10th_percentile": 55.86, "90th_percentile": 55.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 55.86, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 55.86, "10th_percentile": 55.86, "90th_percentile": 55.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 133.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 133.0, "10th_percentile": 133.0, "90th_percentile": 133.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 133.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 133.0, "10th_percentile": 133.0, "90th_percentile": 133.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 133.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 133.0, "10th_percentile": 133.0, "90th_percentile": 133.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 133.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 133.0, "10th_percentile": 133.0, "90th_percentile": 133.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 133.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 133.0, "10th_percentile": 133.0, "90th_percentile": 133.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Crossmatch Incubated Each Unit", "code_information": [ { "code": "PX-30208340", "type": "CDM" }, { "code": "86921", "type": "CPT" }, { "code": "0302", "type": "RC" } ], "standard_charges": [ { "minimum": 75.18, "maximum": 179.0, "setting": "outpatient", "gross_charge": 179.0, "discounted_cash": 125.3, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $179.00 @ 12.5% = $22.38 due to $0.00 Claim Price", "median_amount": 22.38, "10th_percentile": 22.38, "90th_percentile": 22.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $179.00 @ 12.5% = $22.38 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $179.00 @ 12.5% = $22.38 due to $0.00 Claim Price", "median_amount": 22.38, "10th_percentile": 22.38, "90th_percentile": 22.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $179.00 @ 12.5% = $22.38 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $179.00 @ 12.5% = $22.38 due to $0.00 Claim Price", "median_amount": 22.38, "10th_percentile": 22.38, "90th_percentile": 22.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $179.00 @ 12.5% = $22.38 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 116.35, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400", "median_amount": 116.35, "10th_percentile": 116.35, "90th_percentile": 116.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 107.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 107.4, "10th_percentile": 107.4, "90th_percentile": 107.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 116.35, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 116.35, "10th_percentile": 116.35, "90th_percentile": 116.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 109.91, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 109.91, "10th_percentile": 109.91, "90th_percentile": 109.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 107.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 107.4, "10th_percentile": 107.4, "90th_percentile": 107.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 100.06, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 100.06, "10th_percentile": 100.06, "90th_percentile": 100.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 104.61, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 104.61, "10th_percentile": 104.61, "90th_percentile": 104.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 97.56, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 97.56, "10th_percentile": 97.56, "90th_percentile": 97.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 97.56, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 97.56, "10th_percentile": 97.56, "90th_percentile": 97.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 97.56, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 97.56, "10th_percentile": 97.56, "90th_percentile": 97.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 75.18, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 75.18, "10th_percentile": 75.18, "90th_percentile": 75.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 75.18, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 75.18, "10th_percentile": 75.18, "90th_percentile": 75.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 119.75, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 119.75, "10th_percentile": 119.75, "90th_percentile": 119.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 116.35, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 116.35, "10th_percentile": 116.35, "90th_percentile": 116.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 155.73, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 155.73, "10th_percentile": 155.73, "90th_percentile": 155.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 143.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 143.2, "10th_percentile": 143.2, "90th_percentile": 143.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 109.91, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 109.91, "10th_percentile": 109.91, "90th_percentile": 109.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 84.13, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 84.13, "10th_percentile": 84.13, "90th_percentile": 84.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 112.77, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 112.77, "10th_percentile": 112.77, "90th_percentile": 112.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 97.29, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 97.29, "10th_percentile": 97.29, "90th_percentile": 97.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 89.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 89.5, "10th_percentile": 89.5, "90th_percentile": 89.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 104.61, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 104.61, "10th_percentile": 104.61, "90th_percentile": 104.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 107.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 107.4, "10th_percentile": 107.4, "90th_percentile": 107.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 107.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 107.4, "10th_percentile": 107.4, "90th_percentile": 107.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 107.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 107.4, "10th_percentile": 107.4, "90th_percentile": 107.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 179.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 179.0, "10th_percentile": 179.0, "90th_percentile": 179.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 179.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 179.0, "10th_percentile": 179.0, "90th_percentile": 179.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 179.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 179.0, "10th_percentile": 179.0, "90th_percentile": 179.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 179.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 179.0, "10th_percentile": 179.0, "90th_percentile": 179.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 179.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 179.0, "10th_percentile": 179.0, "90th_percentile": 179.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Culture Typing, Immunologic Not If", "code_information": [ { "code": "PX-30613110", "type": "CDM" }, { "code": "87147", "type": "CPT" }, { "code": "0306", "type": "RC" } ], "standard_charges": [ { "minimum": 28.14, "maximum": 67.0, "setting": "outpatient", "gross_charge": 67.0, "discounted_cash": 46.9, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_algorithm": "No contract line matched", "median_amount": 67.0, "10th_percentile": 67.0, "90th_percentile": 67.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 67.0, "10th_percentile": 67.0, "90th_percentile": 67.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 67.0, "10th_percentile": 67.0, "90th_percentile": 67.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 67.0, "10th_percentile": 67.0, "90th_percentile": 67.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_algorithm": "No contract line matched", "median_amount": 67.0, "10th_percentile": 67.0, "90th_percentile": 67.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 67.0, "10th_percentile": 67.0, "90th_percentile": 67.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 67.0, "10th_percentile": 67.0, "90th_percentile": 67.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_algorithm": "No contract line matched", "median_amount": 67.0, "10th_percentile": 67.0, "90th_percentile": 67.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_algorithm": "No contract line matched", "median_amount": 67.0, "10th_percentile": 67.0, "90th_percentile": 67.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $67.00 @ 12.5% = $8.38 due to $0.00 Claim Price", "median_amount": 8.38, "10th_percentile": 8.38, "90th_percentile": 8.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $67.00 @ 12.5% = $8.38 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $67.00 @ 12.5% = $8.38 due to $0.00 Claim Price", "median_amount": 8.38, "10th_percentile": 8.38, "90th_percentile": 8.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $67.00 @ 12.5% = $8.38 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $67.00 @ 12.5% = $8.38 due to $0.00 Claim Price", "median_amount": 8.38, "10th_percentile": 8.38, "90th_percentile": 8.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $67.00 @ 12.5% = $8.38 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 41.14, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 41.14, "10th_percentile": 41.14, "90th_percentile": 41.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 37.45, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 37.45, "10th_percentile": 37.45, "90th_percentile": 37.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 39.15, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 39.15, "10th_percentile": 39.15, "90th_percentile": 39.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 36.52, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 36.52, "10th_percentile": 36.52, "90th_percentile": 36.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 36.52, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 36.52, "10th_percentile": 36.52, "90th_percentile": 36.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 36.52, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 36.52, "10th_percentile": 36.52, "90th_percentile": 36.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 28.14, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 28.14, "10th_percentile": 28.14, "90th_percentile": 28.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 28.14, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 28.14, "10th_percentile": 28.14, "90th_percentile": 28.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 44.82, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.82, "10th_percentile": 44.82, "90th_percentile": 44.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 41.14, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 41.14, "10th_percentile": 41.14, "90th_percentile": 41.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 33.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 33.5, "10th_percentile": 33.5, "90th_percentile": 33.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 31.49, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 31.49, "10th_percentile": 31.49, "90th_percentile": 31.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 36.41, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 36.41, "10th_percentile": 36.41, "90th_percentile": 36.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 39.15, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 39.15, "10th_percentile": 39.15, "90th_percentile": 39.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 42.21, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 42.21, "10th_percentile": 42.21, "90th_percentile": 42.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 40.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.2, "10th_percentile": 40.2, "90th_percentile": 40.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 67.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 67.0, "10th_percentile": 67.0, "90th_percentile": 67.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 67.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 67.0, "10th_percentile": 67.0, "90th_percentile": 67.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 67.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 67.0, "10th_percentile": 67.0, "90th_percentile": 67.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 67.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 67.0, "10th_percentile": 67.0, "90th_percentile": 67.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 67.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 67.0, "10th_percentile": 67.0, "90th_percentile": 67.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Cv Strs Tst Xers&/or Rx Cont Ecg W/Si&R", "code_information": [ { "code": "PX-48000103", "type": "CDM" }, { "code": "93015", "type": "CPT" }, { "code": "0480", "type": "RC" } ], "standard_charges": [ { "minimum": 258.72, "maximum": 616.0, "setting": "outpatient", "gross_charge": 616.0, "discounted_cash": 431.2, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC CORE", "standard_charge_algorithm": "No contract line matched", "median_amount": 616.0, "10th_percentile": 616.0, "90th_percentile": 616.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH UHC ALL OTHER", "standard_charge_algorithm": "No contract line matched", "median_amount": 616.0, "10th_percentile": 616.0, "90th_percentile": 616.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $616.00 @ 12.5% = $77.00 due to $0.00 Claim Price", "median_amount": 77.0, "10th_percentile": 77.0, "90th_percentile": 77.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $616.00 @ 12.5% = $77.00 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $616.00 @ 12.5% = $77.00 due to $0.00 Claim Price", "median_amount": 77.0, "10th_percentile": 77.0, "90th_percentile": 77.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $616.00 @ 12.5% = $77.00 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $616.00 @ 12.5% = $77.00 due to $0.00 Claim Price", "median_amount": 77.0, "10th_percentile": 77.0, "90th_percentile": 77.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $616.00 @ 12.5% = $77.00 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 400.4, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 369.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 369.6, "10th_percentile": 369.6, "90th_percentile": 369.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 378.22, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 378.22, "10th_percentile": 378.22, "90th_percentile": 378.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 369.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 369.6, "10th_percentile": 369.6, "90th_percentile": 369.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 344.34, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 344.34, "10th_percentile": 344.34, "90th_percentile": 344.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 359.99, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 359.99, "10th_percentile": 359.99, "90th_percentile": 359.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 335.72, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 335.72, "10th_percentile": 335.72, "90th_percentile": 335.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 335.72, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 335.72, "10th_percentile": 335.72, "90th_percentile": 335.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 335.72, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 335.72, "10th_percentile": 335.72, "90th_percentile": 335.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 258.72, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 258.72, "10th_percentile": 258.72, "90th_percentile": 258.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 258.72, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 258.72, "10th_percentile": 258.72, "90th_percentile": 258.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 378.22, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 378.22, "10th_percentile": 378.22, "90th_percentile": 378.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 308.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 308.0, "10th_percentile": 308.0, "90th_percentile": 308.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 412.1, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 412.1, "10th_percentile": 412.1, "90th_percentile": 412.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 535.92, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 535.92, "10th_percentile": 535.92, "90th_percentile": 535.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 492.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 492.8, "10th_percentile": 492.8, "90th_percentile": 492.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 359.99, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 359.99, "10th_percentile": 359.99, "90th_percentile": 359.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 388.08, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 388.08, "10th_percentile": 388.08, "90th_percentile": 388.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 289.52, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 289.52, "10th_percentile": 289.52, "90th_percentile": 289.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 334.8, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 334.8, "10th_percentile": 334.8, "90th_percentile": 334.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 369.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 369.6, "10th_percentile": 369.6, "90th_percentile": 369.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 369.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 369.6, "10th_percentile": 369.6, "90th_percentile": 369.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MRH DREYER - IPA", "standard_charge_dollar": 369.6, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 369.6, "10th_percentile": 369.6, "90th_percentile": 369.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 616.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 616.0, "10th_percentile": 616.0, "90th_percentile": 616.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 616.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 616.0, "10th_percentile": 616.0, "90th_percentile": 616.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 616.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 616.0, "10th_percentile": 616.0, "90th_percentile": 616.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 616.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 616.0, "10th_percentile": 616.0, "90th_percentile": 616.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 616.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 616.0, "10th_percentile": 616.0, "90th_percentile": 616.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Cystatin C Egfr", "code_information": [ { "code": "PX-30105229", "type": "CDM" }, { "code": "82610", "type": "CPT" }, { "code": "0301", "type": "RC" } ], "standard_charges": [ { "minimum": 47.04, "maximum": 112.0, "setting": "outpatient", "gross_charge": 112.0, "discounted_cash": 78.4, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_algorithm": "No contract line matched", "median_amount": 112.0, "10th_percentile": 112.0, "90th_percentile": 112.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH AETNA", "standard_charge_algorithm": "No contract line matched", "median_amount": 112.0, "10th_percentile": 112.0, "90th_percentile": 112.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA", "standard_charge_algorithm": "No contract line matched", "median_amount": 112.0, "10th_percentile": 112.0, "90th_percentile": 112.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $112.00 @ 12.5% = $14.00 due to $0.00 Claim Price", "median_amount": 14.0, "10th_percentile": 14.0, "90th_percentile": 14.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $112.00 @ 12.5% = $14.00 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $112.00 @ 12.5% = $14.00 due to $0.00 Claim Price", "median_amount": 14.0, "10th_percentile": 14.0, "90th_percentile": 14.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $112.00 @ 12.5% = $14.00 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "MRH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $112.00 @ 12.5% = $14.00 due to $0.00 Claim Price", "median_amount": 14.0, "10th_percentile": 14.0, "90th_percentile": 14.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NWR; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $112.00 @ 12.5% = $14.00 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 47.04, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 47.04, "10th_percentile": 47.04, "90th_percentile": 47.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 47.04, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 47.04, "10th_percentile": 47.04, "90th_percentile": 47.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 67.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 67.2, "10th_percentile": 67.2, "90th_percentile": 67.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 67.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 67.2, "10th_percentile": 67.2, "90th_percentile": 67.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA NARROW", "standard_charge_dollar": 67.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.2, "10th_percentile": 67.2, "90th_percentile": 67.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 60% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH AETNA NM EMPLOYEES", "standard_charge_dollar": 52.64, "standard_charge_percentage": 47.0, "standard_charge_algorithm": "All Services; 47% Billed", "median_amount": 52.64, "10th_percentile": 52.64, "90th_percentile": 52.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 47% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "MRH SEIU HEALTHLINK", "standard_charge_dollar": 70.56, "standard_charge_percentage": 63.0, "standard_charge_algorithm": "Outpatient Services; 63% Billed", "median_amount": 70.56, "10th_percentile": 70.56, "90th_percentile": 70.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 63% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "MRH THE ALLIANCE", "standard_charge_dollar": 60.87, "standard_charge_percentage": 54.35, "standard_charge_algorithm": "Outpatient Services; 54.35% Billed", "median_amount": 60.87, "10th_percentile": 60.87, "90th_percentile": 60.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 54.35% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "MRH CIGNA BROAD", "standard_charge_dollar": 56.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Other OP; 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": 56.0, "10th_percentile": 56.0, "90th_percentile": 56.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 65.45, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 65.45, "10th_percentile": 65.45, "90th_percentile": 65.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 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": "MRH BCBS PPO", "standard_charge_dollar": 68.77, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 68.77, "10th_percentile": 68.77, "90th_percentile": 68.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 89.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 89.6, "10th_percentile": 89.6, "90th_percentile": 89.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "MRH HFN", "standard_charge_dollar": 97.44, "standard_charge_percentage": 87.0, "standard_charge_algorithm": "All Services; 87% Billed", "median_amount": 97.44, "10th_percentile": 97.44, "90th_percentile": 97.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 87% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 72.8, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 72.8, "10th_percentile": 72.8, "90th_percentile": 72.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 74.93, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 74.93, "10th_percentile": 74.93, "90th_percentile": 74.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DUPAGE MEDICAL GROUP (IHP)", "standard_charge_dollar": 72.8, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Outpatient Services; 65% Billed", "median_amount": 72.8, "10th_percentile": 72.8, "90th_percentile": 72.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 67.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400", "median_amount": 67.2, "10th_percentile": 67.2, "90th_percentile": 67.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 67.2, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 67.2, "10th_percentile": 67.2, "90th_percentile": 67.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PPO", "standard_charge_dollar": 68.77, "standard_charge_percentage": 61.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed", "median_amount": 68.77, "10th_percentile": 68.77, "90th_percentile": 68.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 61.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 65.45, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 65.45, "10th_percentile": 65.45, "90th_percentile": 65.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 62.61, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 62.61, "10th_percentile": 62.61, "90th_percentile": 62.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 61.04, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 61.04, "10th_percentile": 61.04, "90th_percentile": 61.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 61.04, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 61.04, "10th_percentile": 61.04, "90th_percentile": 61.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 61.04, "standard_charge_percentage": 54.5, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed", "median_amount": 61.04, "10th_percentile": 61.04, "90th_percentile": 61.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 54.5% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 112.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 112.0, "10th_percentile": 112.0, "90th_percentile": 112.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 112.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 112.0, "10th_percentile": 112.0, "90th_percentile": 112.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 112.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 112.0, "10th_percentile": 112.0, "90th_percentile": 112.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 112.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 112.0, "10th_percentile": 112.0, "90th_percentile": 112.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH NON-CONTRACTED PAYORS", "standard_charge_dollar": 112.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 112.0, "10th_percentile": 112.0, "90th_percentile": 112.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "HB Cystoscopy and Treatment W/Dilation Male & Female", "code_information": [ { "code": "PX-36100619", "type": "CDM" }, { "code": "52281", "type": "CPT" }, { "code": "0761", "type": "RC" } ], "standard_charges": [ { "minimum": 4636.38, "maximum": 11039.0, "setting": "outpatient", "gross_charge": 11039.0, "discounted_cash": 7727.3, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 11039.0, "10th_percentile": 11039.0, "90th_percentile": 11039.0, "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": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 11039.0, "10th_percentile": 11039.0, "90th_percentile": 11039.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "MRH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 11039.0, "10th_percentile": 11039.0, "90th_percentile": 11039.0, "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": "MRH UNIVERSITY OF IL MED CENTER - IPA", "standard_charge_dollar": 6623.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed, and; Pricing Extension - NM HB XR PRC - DAILY REIMBURSEMENT LIMIT $400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH LOYOLA UNIVERSITY MED CENTER - IPA", "standard_charge_dollar": 7175.35, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26.", "median_amount": 400.0, "10th_percentile": 400.0, "90th_percentile": 400.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 65% Billed, and; Pricing Extension - HB XR OP MAX DAILY 400; Note: Daily limit of $400.00 reached for 02/02/26." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH DREYER - IPA", "standard_charge_dollar": 6623.4, "standard_charge_percentage": 60.0, "standard_charge_algorithm": "All Other Outpatient; 60% Billed", "median_amount": 6623.4, "10th_percentile": 6623.4, "90th_percentile": 6623.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 60% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 6170.8, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed", "median_amount": 6170.8, "10th_percentile": 6170.8, "90th_percentile": 6170.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services. ADP RATE (for patient estimates only); 55.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "MRH BCBS HMO", "standard_charge_dollar": 6451.19, "standard_charge_percentage": 58.44, "standard_charge_algorithm": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6451.19, "10th_percentile": 6451.19, "90th_percentile": 6451.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 58.44% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 4636.38, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 4636.38, "10th_percentile": 4636.38, "90th_percentile": 4636.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "MRH IMAGINE HEALTH", "standard_charge_dollar": 4636.38, "standard_charge_percentage": 42.0, "standard_charge_algorithm": "Outpatient Services; 42% Billed", "median_amount": 4636.38, "10th_percentile": 4636.38, "90th_percentile": 4636.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 42% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MRH PHCS", "standard_charge_dollar": 8831.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Outpatient; 80% Billed", "median_amount": 8831.2, "10th_percentile": 8831.2, "90th_percentile": 8831.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 80% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "MRH FIRST HEALTH", "standard_charge_dollar": 7385.09, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "All Other Outpatient; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7385.09, "10th_percentile": 7385.09, "90th_percentile": 7385.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 66.9% Billed,