{ "hospital_name": "Northwestern Memorial Hospital", "last_updated_on": "2026-04-01", "version": "3.0.0", "location_name": [ "Northwestern Memorial Hospital", "Northwestern Medicine Prentice Women's Hospital" ], "hospital_address": [ "251 E. Huron, Chicago, IL 60611", "250 E. Superior Street, Chicago, IL 60611" ], "license_information": { "license_number": "0003251", "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": [ "1497859649", "1831298926" ], "standard_charge_information": [ { "description": "1 Stg Dstl Hypospadias Rpr W/Urtp Skin Flaps", "code_information": [ { "code": "CASE-54324", "type": "LOCAL" }, { "code": "54324", "type": "CPT" }, { "code": "0360", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44491.53, "discounted_cash": 31144.07, "payers_information": [ { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_percentage": 58.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "median_amount": 25805.1, "10th_percentile": 25805.1, "90th_percentile": 25805.1, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "median_amount": 31144.09, "10th_percentile": 31144.09, "90th_percentile": 31144.09, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 23.4, "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "median_amount": 10411.0, "10th_percentile": 10411.0, "90th_percentile": 10411.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "median_amount": 22245.79, "10th_percentile": 22245.79, "90th_percentile": 22245.79, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "median_amount": 22245.79, "10th_percentile": 22245.79, "90th_percentile": 22245.79, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "median_amount": 12012.71, "10th_percentile": 12012.71, "90th_percentile": 12012.71, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "median_amount": 12012.71, "10th_percentile": 12012.71, "90th_percentile": 12012.71, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "median_amount": 20021.2, "10th_percentile": 20021.2, "90th_percentile": 20021.2, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "median_amount": 20021.2, "10th_percentile": 20021.2, "90th_percentile": 20021.2, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "median_amount": 20021.2, "10th_percentile": 20021.2, "90th_percentile": 20021.2, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "median_amount": 44491.53, "10th_percentile": 44491.53, "90th_percentile": 44491.53, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "median_amount": 44491.53, "10th_percentile": 44491.53, "90th_percentile": 44491.53, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "median_amount": 44491.53, "10th_percentile": 44491.53, "90th_percentile": 44491.53, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "median_amount": 44491.53, "10th_percentile": 44491.53, "90th_percentile": 44491.53, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "median_amount": 44491.53, "10th_percentile": 44491.53, "90th_percentile": 44491.53, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "median_amount": 44491.53, "10th_percentile": 44491.53, "90th_percentile": 44491.53, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "median_amount": 44491.53, "10th_percentile": 44491.53, "90th_percentile": 44491.53, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "median_amount": 44491.53, "10th_percentile": 44491.53, "90th_percentile": 44491.53, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "median_amount": 44491.53, "10th_percentile": 44491.53, "90th_percentile": 44491.53, "count": "1 through 10", "methodology": "percent of total billed charges" } ] } ] }, { "description": "1.5MM LOK SCRW SLF-TPNG W T4 STARDRV RECESS 24MM", "code_information": [ { "code": "SUP-377070", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 86.81, "maximum": 848.8, "setting": "outpatient", "gross_charge": 848.8, "discounted_cash": 594.16, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 229.18, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 175.0, "10th_percentile": 131.66, "90th_percentile": 218.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 120.82, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 175.0, "10th_percentile": 131.66, "90th_percentile": 218.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 229.18, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 229.18, "10th_percentile": 229.18, "90th_percentile": 229.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 424.4, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 424.4, "10th_percentile": 424.4, "90th_percentile": 424.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 223.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 324.07, "10th_percentile": 243.81, "90th_percentile": 404.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 424.4, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 324.07, "10th_percentile": 243.81, "90th_percentile": 404.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 198.62, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 198.62, "10th_percentile": 198.62, "90th_percentile": 198.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 594.16, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 594.16, "10th_percentile": 594.16, "90th_percentile": 594.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 492.3, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 492.3, "10th_percentile": 492.3, "90th_percentile": 492.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 201.37, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 291.66, "10th_percentile": 219.43, "90th_percentile": 363.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 381.96, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 291.66, "10th_percentile": 219.43, "90th_percentile": 363.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 381.96, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 381.96, "10th_percentile": 381.96, "90th_percentile": 381.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 381.96, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 381.96, "10th_percentile": 381.96, "90th_percentile": 381.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 447.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 648.14, "10th_percentile": 487.62, "90th_percentile": 808.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 848.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 648.14, "10th_percentile": 487.62, "90th_percentile": 808.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 848.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 848.8, "10th_percentile": 848.8, "90th_percentile": 848.8, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 848.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 848.8, "10th_percentile": 848.8, "90th_percentile": 848.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 447.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 648.14, "10th_percentile": 487.62, "90th_percentile": 808.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 848.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 648.14, "10th_percentile": 487.62, "90th_percentile": 808.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 848.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 648.14, "10th_percentile": 487.62, "90th_percentile": 808.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 447.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 648.14, "10th_percentile": 487.62, "90th_percentile": 808.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 848.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 648.14, "10th_percentile": 487.62, "90th_percentile": 808.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 447.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 648.14, "10th_percentile": 487.62, "90th_percentile": 808.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 447.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 648.14, "10th_percentile": 487.62, "90th_percentile": 808.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 848.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 648.14, "10th_percentile": 487.62, "90th_percentile": 808.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 848.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 648.14, "10th_percentile": 487.62, "90th_percentile": 808.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 447.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 648.14, "10th_percentile": 487.62, "90th_percentile": 808.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 447.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 648.14, "10th_percentile": 487.62, "90th_percentile": 808.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 848.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 648.14, "10th_percentile": 487.62, "90th_percentile": 808.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 104.27, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 289.97, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 134.25, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 259.99, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 86.81, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 357.99, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 447.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $447.49 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 447.49, "10th_percentile": 447.49, "90th_percentile": 447.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $447.49 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 357.99, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 357.99, "10th_percentile": 357.99, "90th_percentile": 357.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 290.87, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 290.87, "10th_percentile": 290.87, "90th_percentile": 290.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 223.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 223.75, "10th_percentile": 223.75, "90th_percentile": 223.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 143.2, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 143.2, "10th_percentile": 143.2, "90th_percentile": 143.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 380.37, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 380.37, "10th_percentile": 380.37, "90th_percentile": 380.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 447.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 447.49, "10th_percentile": 447.49, "90th_percentile": 447.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 366.94, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 366.94, "10th_percentile": 366.94, "90th_percentile": 366.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 260.89, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 260.89, "10th_percentile": 260.89, "90th_percentile": 260.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 157.96, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 157.96, "10th_percentile": 157.96, "90th_percentile": 157.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 179.0, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% 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 Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 179.0, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% 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 Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 447.49, "10th_percentile": 447.49, "90th_percentile": 447.49, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 447.49, "10th_percentile": 447.49, "90th_percentile": 447.49, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 447.49, "10th_percentile": 447.49, "90th_percentile": 447.49, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 447.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 447.49, "10th_percentile": 447.49, "90th_percentile": 447.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "1.5MM TI CORTEX SCREW SELF-TAPPING 6MM", "code_information": [ { "code": "SUP-49999", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 29.2, "maximum": 732.76, "setting": "outpatient", "gross_charge": 135.69, "discounted_cash": 94.98, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 36.64, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 117.75, "10th_percentile": 38.64, "90th_percentile": 191.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 40.64, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 117.75, "10th_percentile": 38.64, "90th_percentile": 191.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 117.45, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 117.75, "10th_percentile": 38.64, "90th_percentile": 191.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 118.04, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 117.75, "10th_percentile": 38.64, "90th_percentile": 191.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 185.57, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 117.75, "10th_percentile": 38.64, "90th_percentile": 191.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 197.85, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 117.75, "10th_percentile": 38.64, "90th_percentile": 191.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 197.85, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 151.81, "10th_percentile": 117.63, "90th_percentile": 194.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 185.57, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 151.81, "10th_percentile": 117.63, "90th_percentile": 194.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 118.04, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 151.81, "10th_percentile": 117.63, "90th_percentile": 194.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 117.45, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 151.81, "10th_percentile": 117.63, "90th_percentile": 194.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 366.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 281.12, "10th_percentile": 217.83, "90th_percentile": 359.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 343.65, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 281.12, "10th_percentile": 217.83, "90th_percentile": 359.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 218.59, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 281.12, "10th_percentile": 217.83, "90th_percentile": 359.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 217.51, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 281.12, "10th_percentile": 217.83, "90th_percentile": 359.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 75.26, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 218.59, "10th_percentile": 132.16, "90th_percentile": 357.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 217.51, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 218.59, "10th_percentile": 132.16, "90th_percentile": 357.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 218.59, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 218.59, "10th_percentile": 132.16, "90th_percentile": 357.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 343.65, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 218.59, "10th_percentile": 132.16, "90th_percentile": 357.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 366.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 218.59, "10th_percentile": 132.16, "90th_percentile": 357.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 171.47, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 160.83, "10th_percentile": 101.99, "90th_percentile": 167.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 160.83, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 160.83, "10th_percentile": 101.99, "90th_percentile": 167.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 160.83, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 160.83, "10th_percentile": 101.99, "90th_percentile": 167.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 102.3, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 160.83, "10th_percentile": 101.99, "90th_percentile": 167.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 101.79, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 160.83, "10th_percentile": 101.99, "90th_percentile": 167.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC SEIU HEALTHLINK", "standard_charge_dollar": 378.02, "standard_charge_percentage": 55.0, "standard_charge_algorithm": "All Services; 55% Billed", "median_amount": 378.02, "10th_percentile": 378.02, "90th_percentile": 378.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 55% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 304.51, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 393.56, "10th_percentile": 304.96, "90th_percentile": 503.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 306.02, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 393.56, "10th_percentile": 304.96, "90th_percentile": 503.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 481.11, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 393.56, "10th_percentile": 304.96, "90th_percentile": 503.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 512.93, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 393.56, "10th_percentile": 304.96, "90th_percentile": 503.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 252.31, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 326.1, "10th_percentile": 252.69, "90th_percentile": 417.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 253.56, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 326.1, "10th_percentile": 252.69, "90th_percentile": 417.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 398.63, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 326.1, "10th_percentile": 252.69, "90th_percentile": 417.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 425.0, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 326.1, "10th_percentile": 252.69, "90th_percentile": 417.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 67.73, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 196.73, "10th_percentile": 118.94, "90th_percentile": 321.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 195.75, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 196.73, "10th_percentile": 118.94, "90th_percentile": 321.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 196.73, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 196.73, "10th_percentile": 118.94, "90th_percentile": 321.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 309.29, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 196.73, "10th_percentile": 118.94, "90th_percentile": 321.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 329.74, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 196.73, "10th_percentile": 118.94, "90th_percentile": 321.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 195.75, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 253.01, "10th_percentile": 196.04, "90th_percentile": 323.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 196.73, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 253.01, "10th_percentile": 196.04, "90th_percentile": 323.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 309.29, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 253.01, "10th_percentile": 196.04, "90th_percentile": 323.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 329.74, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 253.01, "10th_percentile": 196.04, "90th_percentile": 323.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 195.75, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 253.01, "10th_percentile": 196.04, "90th_percentile": 323.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 196.73, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 253.01, "10th_percentile": 196.04, "90th_percentile": 323.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 309.29, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 253.01, "10th_percentile": 196.04, "90th_percentile": 323.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 329.74, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 253.01, "10th_percentile": 196.04, "90th_percentile": 323.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 732.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 687.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 437.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 435.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 150.52, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 135.69, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 435.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 562.24, "10th_percentile": 435.66, "90th_percentile": 719.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 437.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 562.24, "10th_percentile": 435.66, "90th_percentile": 719.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 687.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 562.24, "10th_percentile": 435.66, "90th_percentile": 719.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 732.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 562.24, "10th_percentile": 435.66, "90th_percentile": 719.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 732.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 437.17, "10th_percentile": 255.42, "90th_percentile": 714.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 687.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 437.17, "10th_percentile": 255.42, "90th_percentile": 714.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 437.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 135.69, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 150.52, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 435.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 732.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 732.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 687.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 150.52, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 135.69, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 135.69, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 150.52, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 435.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 437.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 687.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 732.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 435.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 437.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 687.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 150.52, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 435.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 437.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 732.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 687.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 437.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 135.69, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 436.09, "10th_percentile": 143.11, "90th_percentile": 710.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 35.07, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 97.54, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 45.16, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 87.45, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 29.2, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 120.42, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 150.52, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $150.52 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 150.52, "10th_percentile": 150.52, "90th_percentile": 150.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $150.52 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 120.42, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 120.42, "10th_percentile": 120.42, "90th_percentile": 120.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 97.84, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 97.84, "10th_percentile": 97.84, "90th_percentile": 97.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 75.26, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 75.26, "10th_percentile": 75.26, "90th_percentile": 75.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 48.17, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 48.17, "10th_percentile": 48.17, "90th_percentile": 48.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 127.94, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 127.94, "10th_percentile": 127.94, "90th_percentile": 127.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 150.52, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 150.52, "10th_percentile": 150.52, "90th_percentile": 150.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 123.43, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 123.43, "10th_percentile": 123.43, "90th_percentile": 123.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 87.75, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 87.75, "10th_percentile": 87.75, "90th_percentile": 87.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 53.13, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 53.13, "10th_percentile": 53.13, "90th_percentile": 53.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 60.21, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 60.21, "10th_percentile": 60.21, "90th_percentile": 60.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 60.21, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 60.21, "10th_percentile": 60.21, "90th_percentile": 60.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 150.52, "10th_percentile": 150.52, "90th_percentile": 150.52, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 150.52, "10th_percentile": 150.52, "90th_percentile": 150.52, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 150.52, "10th_percentile": 150.52, "90th_percentile": 150.52, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 150.52, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.52, "10th_percentile": 150.52, "90th_percentile": 150.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "105MM PRE BENT SPHERX ROD", "code_information": [ { "code": "SUP-307196", "type": "CDM" }, { "code": "C1889", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 313.89, "maximum": 4333.69, "setting": "outpatient", "gross_charge": 1502.38, "discounted_cash": 1051.67, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1502.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1617.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3069.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4333.69, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1502.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1617.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3069.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4333.69, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1502.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1617.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3069.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4333.69, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1502.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1617.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3069.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4333.69, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4333.69, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3069.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1617.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1502.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4333.69, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3069.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1617.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1502.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4333.69, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3069.01, "10th_percentile": 1815.71, "90th_percentile": 4080.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3069.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3069.01, "10th_percentile": 1815.71, "90th_percentile": 4080.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1502.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3069.01, "10th_percentile": 1815.71, "90th_percentile": 4080.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3069.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3701.35, "10th_percentile": 3195.48, "90th_percentile": 4207.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4333.69, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3701.35, "10th_percentile": 3195.48, "90th_percentile": 4207.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1502.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1617.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 3069.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 4333.69, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 2343.49, "10th_percentile": 1537.06, "90th_percentile": 3954.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC SEIU HEALTHLINK", "standard_charge_dollar": 2383.53, "standard_charge_percentage": 55.0, "standard_charge_algorithm": "All Services; 55% Billed", "median_amount": 2383.53, "10th_percentile": 2383.53, "90th_percentile": 2383.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 55% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 2148.31, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 2590.94, "10th_percentile": 2236.84, "90th_percentile": 2945.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 3033.58, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 2590.94, "10th_percentile": 2236.84, "90th_percentile": 2945.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1780.03, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 2146.78, "10th_percentile": 1853.38, "90th_percentile": 2440.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 2513.54, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 2146.78, "10th_percentile": 1853.38, "90th_percentile": 2440.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1014.08, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1014.08, "10th_percentile": 777.34, "90th_percentile": 1014.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1014.08, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1014.08, "10th_percentile": 777.34, "90th_percentile": 1014.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 718.15, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1014.08, "10th_percentile": 777.34, "90th_percentile": 1014.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1534.51, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1850.68, "10th_percentile": 1597.74, "90th_percentile": 2103.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2166.85, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1850.68, "10th_percentile": 1597.74, "90th_percentile": 2103.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2166.85, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1534.51, "10th_percentile": 954.09, "90th_percentile": 2040.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1534.51, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1534.51, "10th_percentile": 954.09, "90th_percentile": 2040.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 808.99, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1534.51, "10th_percentile": 954.09, "90th_percentile": 2040.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 828.63, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 999.37, "10th_percentile": 862.78, "90th_percentile": 1135.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1170.1, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 999.37, "10th_percentile": 862.78, "90th_percentile": 1135.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 405.64, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 632.74, "10th_percentile": 415.0, "90th_percentile": 1067.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 436.85, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 632.74, "10th_percentile": 415.0, "90th_percentile": 1067.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 828.63, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 632.74, "10th_percentile": 415.0, "90th_percentile": 1067.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1170.1, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 632.74, "10th_percentile": 415.0, "90th_percentile": 1067.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 1381.05, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1665.61, "10th_percentile": 1437.96, "90th_percentile": 1893.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 1950.16, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1665.61, "10th_percentile": 1437.96, "90th_percentile": 1893.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1381.05, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1665.61, "10th_percentile": 1437.96, "90th_percentile": 1893.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1950.16, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1665.61, "10th_percentile": 1437.96, "90th_percentile": 1893.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1950.16, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1381.05, "10th_percentile": 858.68, "90th_percentile": 1836.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1381.05, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1381.05, "10th_percentile": 858.68, "90th_percentile": 1836.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 728.09, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1381.05, "10th_percentile": 858.68, "90th_percentile": 1836.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 940.05, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 576.35, "10th_percentile": 576.35, "90th_percentile": 576.35, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 1048.45, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 565.44, "10th_percentile": 565.44, "90th_percentile": 565.44, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 313.89, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 242.44, "10th_percentile": 242.44, "90th_percentile": 242.44, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1617.98, "10th_percentile": 1617.98, "90th_percentile": 1617.98, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 1617.98, "10th_percentile": 1617.98, "90th_percentile": 1617.98, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 1617.98, "10th_percentile": 1617.98, "90th_percentile": 1617.98, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 376.99, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 251.3, "10th_percentile": 251.3, "90th_percentile": 251.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 485.39, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 98.96, "10th_percentile": 98.96, "90th_percentile": 98.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 1617.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,617.98 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1617.98, "10th_percentile": 1617.98, "90th_percentile": 1617.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,617.98 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1617.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1617.98, "10th_percentile": 1617.98, "90th_percentile": 1617.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 517.75, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 517.75, "10th_percentile": 517.75, "90th_percentile": 517.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 571.15, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 571.15, "10th_percentile": 571.15, "90th_percentile": 571.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 1294.38, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 1294.38, "10th_percentile": 1294.38, "90th_percentile": 1294.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1051.69, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 1051.69, "10th_percentile": 1051.69, "90th_percentile": 1051.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 1375.28, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 1375.28, "10th_percentile": 1375.28, "90th_percentile": 1375.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 808.99, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 808.99, "10th_percentile": 808.99, "90th_percentile": 808.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 1294.38, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 1294.38, "10th_percentile": 1294.38, "90th_percentile": 1294.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 943.28, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 943.28, "10th_percentile": 943.28, "90th_percentile": 943.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 1326.74, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 1326.74, "10th_percentile": 1326.74, "90th_percentile": 1326.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1617.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1617.98, "10th_percentile": 1617.98, "90th_percentile": 1617.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 647.19, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 647.19, "10th_percentile": 647.19, "90th_percentile": 647.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 647.19, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 647.19, "10th_percentile": 647.19, "90th_percentile": 647.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" } ] } ] }, { "description": "16MM X10 CROSSLINK FIXED", "code_information": [ { "code": "SUP-108409", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 779.7, "maximum": 3332.07, "setting": "outpatient", "gross_charge": 3332.07, "discounted_cash": 2332.45, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 899.66, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 899.66, "10th_percentile": 899.66, "90th_percentile": 899.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 899.66, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 899.66, "10th_percentile": 899.66, "90th_percentile": 899.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1666.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1666.04, "10th_percentile": 1666.04, "90th_percentile": 1666.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1666.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1666.04, "10th_percentile": 1666.04, "90th_percentile": 1666.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1932.6, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1932.6, "10th_percentile": 1932.6, "90th_percentile": 1932.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 2332.45, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 2332.45, "10th_percentile": 2332.45, "90th_percentile": 2332.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1499.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1499.43, "10th_percentile": 1499.43, "90th_percentile": 1499.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1499.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1499.43, "10th_percentile": 1499.43, "90th_percentile": 1499.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 1499.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1499.43, "10th_percentile": 1499.43, "90th_percentile": 1499.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "2.4/2.7MM VA-LOK X-PLT EXTRA SM", "code_information": [ { "code": "SUP-377054", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 481.41, "maximum": 7041.01, "setting": "outpatient", "gross_charge": 7041.01, "discounted_cash": 4928.71, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1901.07, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1002.25, "10th_percentile": 644.83, "90th_percentile": 1721.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1002.25, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1002.25, "10th_percentile": 644.83, "90th_percentile": 1721.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 555.48, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1002.25, "10th_percentile": 644.83, "90th_percentile": 1721.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 555.48, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1228.28, "10th_percentile": 690.04, "90th_percentile": 1766.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1901.07, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1228.28, "10th_percentile": 690.04, "90th_percentile": 1766.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3520.51, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3520.51, "10th_percentile": 3520.51, "90th_percentile": 3520.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1856.01, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2688.26, "10th_percentile": 2022.46, "90th_percentile": 3354.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3520.51, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2688.26, "10th_percentile": 2022.46, "90th_percentile": 3354.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 481.41, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1064.5, "10th_percentile": 598.03, "90th_percentile": 1530.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1647.6, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1064.5, "10th_percentile": 598.03, "90th_percentile": 1530.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC SEIU HEALTHLINK", "standard_charge_dollar": 1324.92, "standard_charge_percentage": 55.0, "standard_charge_algorithm": "All Services; 55% Billed", "median_amount": 1324.92, "10th_percentile": 1324.92, "90th_percentile": 1324.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 55% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 4928.71, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 4928.71, "10th_percentile": 4928.71, "90th_percentile": 4928.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 4083.79, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 4083.79, "10th_percentile": 4083.79, "90th_percentile": 4083.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1670.41, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2419.43, "10th_percentile": 1820.21, "90th_percentile": 3018.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3168.45, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2419.43, "10th_percentile": 1820.21, "90th_percentile": 3018.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3168.45, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3168.45, "10th_percentile": 3168.45, "90th_percentile": 3168.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 3168.45, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3168.45, "10th_percentile": 3168.45, "90th_percentile": 3168.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 3712.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 5376.52, "10th_percentile": 4044.92, "90th_percentile": 6708.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 7041.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 5376.52, "10th_percentile": 4044.92, "90th_percentile": 6708.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7041.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7041.01, "10th_percentile": 7041.01, "90th_percentile": 7041.01, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7041.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7041.01, "10th_percentile": 7041.01, "90th_percentile": 7041.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3712.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5376.52, "10th_percentile": 4044.92, "90th_percentile": 6708.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7041.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5376.52, "10th_percentile": 4044.92, "90th_percentile": 6708.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3712.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5376.52, "10th_percentile": 4044.92, "90th_percentile": 6708.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7041.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5376.52, "10th_percentile": 4044.92, "90th_percentile": 6708.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3712.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5376.52, "10th_percentile": 4044.92, "90th_percentile": 6708.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7041.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5376.52, "10th_percentile": 4044.92, "90th_percentile": 6708.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3712.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5376.52, "10th_percentile": 4044.92, "90th_percentile": 6708.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7041.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5376.52, "10th_percentile": 4044.92, "90th_percentile": 6708.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3712.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5376.52, "10th_percentile": 4044.92, "90th_percentile": 6708.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7041.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5376.52, "10th_percentile": 4044.92, "90th_percentile": 6708.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3712.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5376.52, "10th_percentile": 4044.92, "90th_percentile": 6708.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7041.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5376.52, "10th_percentile": 4044.92, "90th_percentile": 6708.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 864.9, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 2405.39, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 1113.61, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 2156.68, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 720.13, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 2969.62, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 3712.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,712.02 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 3712.02, "10th_percentile": 3712.02, "90th_percentile": 3712.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,712.02 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 2969.62, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 2969.62, "10th_percentile": 2969.62, "90th_percentile": 2969.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2412.81, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 2412.81, "10th_percentile": 2412.81, "90th_percentile": 2412.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 1856.01, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1856.01, "10th_percentile": 1856.01, "90th_percentile": 1856.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 1187.85, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1187.85, "10th_percentile": 1187.85, "90th_percentile": 1187.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 3155.22, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 3155.22, "10th_percentile": 3155.22, "90th_percentile": 3155.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3712.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3712.02, "10th_percentile": 3712.02, "90th_percentile": 3712.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 3043.86, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 3043.86, "10th_percentile": 3043.86, "90th_percentile": 3043.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 2164.11, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2164.11, "10th_percentile": 2164.11, "90th_percentile": 2164.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 1310.34, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 1310.34, "10th_percentile": 1310.34, "90th_percentile": 1310.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 1484.81, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 1484.81, "10th_percentile": 1484.81, "90th_percentile": 1484.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 1484.81, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 1484.81, "10th_percentile": 1484.81, "90th_percentile": 1484.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 3712.02, "10th_percentile": 3712.02, "90th_percentile": 3712.02, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 3712.02, "10th_percentile": 3712.02, "90th_percentile": 3712.02, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3712.02, "10th_percentile": 3712.02, "90th_percentile": 3712.02, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3712.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3712.02, "10th_percentile": 3712.02, "90th_percentile": 3712.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "2.4MM TI CRTX SCRW ST 18MM", "code_information": [ { "code": "SUP-377166", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 44.19, "maximum": 646.25, "setting": "outpatient", "gross_charge": 188.83, "discounted_cash": 132.18, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 50.98, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 87.46, "10th_percentile": 60.56, "90th_percentile": 149.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 82.93, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 87.46, "10th_percentile": 60.56, "90th_percentile": 149.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 91.99, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 87.46, "10th_percentile": 60.56, "90th_percentile": 149.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 174.49, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 87.46, "10th_percentile": 60.56, "90th_percentile": 149.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 50.98, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 112.73, "10th_percentile": 63.33, "90th_percentile": 162.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 174.49, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 112.73, "10th_percentile": 63.33, "90th_percentile": 162.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 323.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 323.13, "10th_percentile": 323.13, "90th_percentile": 323.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 170.35, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 246.74, "10th_percentile": 185.63, "90th_percentile": 307.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 323.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 246.74, "10th_percentile": 185.63, "90th_percentile": 307.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 44.19, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 97.7, "10th_percentile": 54.89, "90th_percentile": 140.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 151.22, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 97.7, "10th_percentile": 54.89, "90th_percentile": 140.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 452.38, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 452.38, "10th_percentile": 452.38, "90th_percentile": 452.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 374.83, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 374.83, "10th_percentile": 374.83, "90th_percentile": 374.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 153.32, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 222.06, "10th_percentile": 167.07, "90th_percentile": 277.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 290.81, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 222.06, "10th_percentile": 167.07, "90th_percentile": 277.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 290.81, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 290.81, "10th_percentile": 290.81, "90th_percentile": 290.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 290.81, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 290.81, "10th_percentile": 290.81, "90th_percentile": 290.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 646.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 340.7, "10th_percentile": 313.85, "90th_percentile": 585.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 340.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 340.7, "10th_percentile": 313.85, "90th_percentile": 585.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 307.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 340.7, "10th_percentile": 313.85, "90th_percentile": 585.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 646.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 646.25, "10th_percentile": 646.25, "90th_percentile": 646.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 307.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 476.69, "10th_percentile": 341.05, "90th_percentile": 612.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 646.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 476.69, "10th_percentile": 341.05, "90th_percentile": 612.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 307.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 340.7, "10th_percentile": 313.85, "90th_percentile": 585.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 340.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 340.7, "10th_percentile": 313.85, "90th_percentile": 585.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 646.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 340.7, "10th_percentile": 313.85, "90th_percentile": 585.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 646.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 340.7, "10th_percentile": 313.85, "90th_percentile": 585.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 340.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 340.7, "10th_percentile": 313.85, "90th_percentile": 585.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 307.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 340.7, "10th_percentile": 313.85, "90th_percentile": 585.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 646.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 340.7, "10th_percentile": 313.85, "90th_percentile": 585.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 340.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 340.7, "10th_percentile": 313.85, "90th_percentile": 585.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 307.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 340.7, "10th_percentile": 313.85, "90th_percentile": 585.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 307.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 340.7, "10th_percentile": 313.85, "90th_percentile": 585.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 340.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 340.7, "10th_percentile": 313.85, "90th_percentile": 585.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 646.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 340.7, "10th_percentile": 313.85, "90th_percentile": 585.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 646.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 340.7, "10th_percentile": 313.85, "90th_percentile": 585.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 340.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 340.7, "10th_percentile": 313.85, "90th_percentile": 585.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 307.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 340.7, "10th_percentile": 313.85, "90th_percentile": 585.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 307.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 340.7, "10th_percentile": 313.85, "90th_percentile": 585.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 340.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 340.7, "10th_percentile": 313.85, "90th_percentile": 585.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 646.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 340.7, "10th_percentile": 313.85, "90th_percentile": 585.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 79.38, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 220.77, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 102.21, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 197.95, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 66.1, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 272.56, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 340.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $340.70 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 340.7, "10th_percentile": 340.7, "90th_percentile": 340.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $340.70 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 272.56, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 272.56, "10th_percentile": 272.56, "90th_percentile": 272.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 221.46, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 221.46, "10th_percentile": 221.46, "90th_percentile": 221.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 170.35, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 170.35, "10th_percentile": 170.35, "90th_percentile": 170.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 109.02, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 109.02, "10th_percentile": 109.02, "90th_percentile": 109.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 289.6, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 289.6, "10th_percentile": 289.6, "90th_percentile": 289.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 340.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 340.7, "10th_percentile": 340.7, "90th_percentile": 340.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 279.37, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 279.37, "10th_percentile": 279.37, "90th_percentile": 279.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 198.63, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 198.63, "10th_percentile": 198.63, "90th_percentile": 198.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 120.27, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 120.27, "10th_percentile": 120.27, "90th_percentile": 120.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 136.28, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 136.28, "10th_percentile": 136.28, "90th_percentile": 136.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 136.28, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 136.28, "10th_percentile": 136.28, "90th_percentile": 136.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 340.7, "10th_percentile": 340.7, "90th_percentile": 340.7, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 340.7, "10th_percentile": 340.7, "90th_percentile": 340.7, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 340.7, "10th_percentile": 340.7, "90th_percentile": 340.7, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 340.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 340.7, "10th_percentile": 340.7, "90th_percentile": 340.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "2.4MM VA-LCP VOLAR RIM DSTL RAD PLT 6H HD 5H SHAFT RT", "code_information": [ { "code": "SUP-377023", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 523.28, "maximum": 7653.41, "setting": "outpatient", "gross_charge": 2236.25, "discounted_cash": 1565.37, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 603.79, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1089.41, "10th_percentile": 700.91, "90th_percentile": 1871.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1089.41, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1089.41, "10th_percentile": 700.91, "90th_percentile": 1871.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2066.42, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1089.41, "10th_percentile": 700.91, "90th_percentile": 1871.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 603.79, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1335.11, "10th_percentile": 750.05, "90th_percentile": 1920.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2066.42, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1335.11, "10th_percentile": 750.05, "90th_percentile": 1920.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3826.71, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3826.71, "10th_percentile": 3826.71, "90th_percentile": 3826.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3826.71, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2922.07, "10th_percentile": 2198.37, "90th_percentile": 3645.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2017.44, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2922.07, "10th_percentile": 2198.37, "90th_percentile": 3645.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 523.28, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1157.09, "10th_percentile": 650.04, "90th_percentile": 1664.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1790.9, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1157.09, "10th_percentile": 650.04, "90th_percentile": 1664.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 5357.39, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 5357.39, "10th_percentile": 5357.39, "90th_percentile": 5357.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 4438.98, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 4438.98, "10th_percentile": 4438.98, "90th_percentile": 4438.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1815.69, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2629.86, "10th_percentile": 1978.52, "90th_percentile": 3281.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3444.03, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2629.86, "10th_percentile": 1978.52, "90th_percentile": 3281.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3444.03, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3444.03, "10th_percentile": 3444.03, "90th_percentile": 3444.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 3444.03, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3444.03, "10th_percentile": 3444.03, "90th_percentile": 3444.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 4034.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 5844.14, "10th_percentile": 4396.72, "90th_percentile": 7291.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 7653.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 5844.14, "10th_percentile": 4396.72, "90th_percentile": 7291.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7653.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7653.41, "10th_percentile": 7653.41, "90th_percentile": 7653.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7653.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7653.41, "10th_percentile": 7653.41, "90th_percentile": 7653.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4034.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5844.14, "10th_percentile": 4396.72, "90th_percentile": 7291.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7653.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5844.14, "10th_percentile": 4396.72, "90th_percentile": 7291.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4034.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5844.14, "10th_percentile": 4396.72, "90th_percentile": 7291.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7653.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5844.14, "10th_percentile": 4396.72, "90th_percentile": 7291.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7653.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5844.14, "10th_percentile": 4396.72, "90th_percentile": 7291.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4034.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5844.14, "10th_percentile": 4396.72, "90th_percentile": 7291.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4034.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5844.14, "10th_percentile": 4396.72, "90th_percentile": 7291.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7653.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5844.14, "10th_percentile": 4396.72, "90th_percentile": 7291.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4034.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5844.14, "10th_percentile": 4396.72, "90th_percentile": 7291.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7653.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5844.14, "10th_percentile": 4396.72, "90th_percentile": 7291.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4034.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5844.14, "10th_percentile": 4396.72, "90th_percentile": 7291.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7653.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5844.14, "10th_percentile": 4396.72, "90th_percentile": 7291.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 940.12, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 2614.6, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 1210.46, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 2344.26, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 782.76, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 3227.9, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 4034.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $4,034.87 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 4034.87, "10th_percentile": 4034.87, "90th_percentile": 4034.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $4,034.87 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 3227.9, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 3227.9, "10th_percentile": 3227.9, "90th_percentile": 3227.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2622.67, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 2622.67, "10th_percentile": 2622.67, "90th_percentile": 2622.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 2017.44, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2017.44, "10th_percentile": 2017.44, "90th_percentile": 2017.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 1291.16, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1291.16, "10th_percentile": 1291.16, "90th_percentile": 1291.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 3429.64, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 3429.64, "10th_percentile": 3429.64, "90th_percentile": 3429.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 4034.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 4034.87, "10th_percentile": 4034.87, "90th_percentile": 4034.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 3308.59, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 3308.59, "10th_percentile": 3308.59, "90th_percentile": 3308.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 2352.33, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2352.33, "10th_percentile": 2352.33, "90th_percentile": 2352.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 1424.31, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 1424.31, "10th_percentile": 1424.31, "90th_percentile": 1424.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 1613.95, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 1613.95, "10th_percentile": 1613.95, "90th_percentile": 1613.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 1613.95, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 1613.95, "10th_percentile": 1613.95, "90th_percentile": 1613.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 4034.87, "10th_percentile": 4034.87, "90th_percentile": 4034.87, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 4034.87, "10th_percentile": 4034.87, "90th_percentile": 4034.87, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4034.87, "10th_percentile": 4034.87, "90th_percentile": 4034.87, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4034.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4034.87, "10th_percentile": 4034.87, "90th_percentile": 4034.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "2.5 X 22MM MEDTRONIC RESOLUTE INTEGRITY RX DRUG ELUTING STENT", "code_information": [ { "code": "SUP-142541", "type": "CDM" }, { "code": "C1874", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 419.07, "maximum": 6129.25, "setting": "outpatient", "gross_charge": 6129.25, "discounted_cash": 4290.47, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6129.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6129.25, "10th_percentile": 6129.25, "90th_percentile": 6129.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3000.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4564.85, "10th_percentile": 3313.34, "90th_percentile": 5816.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3000.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4564.85, "10th_percentile": 3313.34, "90th_percentile": 5816.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3000.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4564.85, "10th_percentile": 3313.34, "90th_percentile": 5816.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3000.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4564.85, "10th_percentile": 3313.34, "90th_percentile": 5816.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3000.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4564.85, "10th_percentile": 3313.34, "90th_percentile": 5816.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3000.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4564.85, "10th_percentile": 3313.34, "90th_percentile": 5816.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3000.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4564.85, "10th_percentile": 3313.34, "90th_percentile": 5816.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6129.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4564.85, "10th_percentile": 3313.34, "90th_percentile": 5816.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6129.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4564.85, "10th_percentile": 3313.34, "90th_percentile": 5816.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6129.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4564.85, "10th_percentile": 3313.34, "90th_percentile": 5816.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6129.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4564.85, "10th_percentile": 3313.34, "90th_percentile": 5816.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6129.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4564.85, "10th_percentile": 3313.34, "90th_percentile": 5816.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6129.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4564.85, "10th_percentile": 3313.34, "90th_percentile": 5816.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6129.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4564.85, "10th_percentile": 3313.34, "90th_percentile": 5816.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 6129.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 4564.85, "10th_percentile": 3313.34, "90th_percentile": 5816.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 3000.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 4564.85, "10th_percentile": 3313.34, "90th_percentile": 5816.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 3554.97, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 3554.97, "10th_percentile": 3554.97, "90th_percentile": 3554.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 4290.48, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 4290.48, "10th_percentile": 4290.48, "90th_percentile": 4290.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1434.24, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 926.65, "10th_percentile": 520.59, "90th_percentile": 1332.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 419.07, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 926.65, "10th_percentile": 520.59, "90th_percentile": 1332.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3064.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3064.63, "10th_percentile": 3064.63, "90th_percentile": 3064.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3064.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3064.63, "10th_percentile": 3064.63, "90th_percentile": 3064.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 483.55, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1069.23, "10th_percentile": 600.69, "90th_percentile": 1537.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1654.9, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1069.23, "10th_percentile": 600.69, "90th_percentile": 1537.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1654.9, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 810.12, "10th_percentile": 548.86, "90th_percentile": 1485.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 810.12, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 810.12, "10th_percentile": 548.86, "90th_percentile": 1485.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 483.55, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 810.12, "10th_percentile": 548.86, "90th_percentile": 1485.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 2758.16, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2758.16, "10th_percentile": 2758.16, "90th_percentile": 2758.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2758.16, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2758.16, "10th_percentile": 2758.16, "90th_percentile": 2758.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2758.16, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2758.16, "10th_percentile": 2758.16, "90th_percentile": 2758.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "2.7MM CORT SCR SELF-TAP SMALL HEX 12MM", "code_information": [ { "code": "SUP-353431", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 20.18, "maximum": 197.29, "setting": "outpatient", "gross_charge": 197.29, "discounted_cash": 138.1, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 53.27, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.67, "10th_percentile": 30.6, "90th_percentile": 50.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 28.08, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.67, "10th_percentile": 30.6, "90th_percentile": 50.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 53.27, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 53.27, "10th_percentile": 53.27, "90th_percentile": 53.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 98.65, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 98.65, "10th_percentile": 98.65, "90th_percentile": 98.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 98.65, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 75.33, "10th_percentile": 56.67, "90th_percentile": 93.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 52.01, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 75.33, "10th_percentile": 56.67, "90th_percentile": 93.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 46.17, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 46.17, "10th_percentile": 46.17, "90th_percentile": 46.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 138.1, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 138.1, "10th_percentile": 138.1, "90th_percentile": 138.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 114.43, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 46.8, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.79, "10th_percentile": 51.0, "90th_percentile": 84.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 88.78, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.79, "10th_percentile": 51.0, "90th_percentile": 84.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 88.78, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 88.78, "10th_percentile": 88.78, "90th_percentile": 88.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 88.78, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 88.78, "10th_percentile": 88.78, "90th_percentile": 88.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 24.23, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 67.4, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 31.2, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 60.43, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 20.18, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 83.21, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $104.01 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 104.01, "10th_percentile": 104.01, "90th_percentile": 104.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $104.01 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 83.21, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 83.21, "10th_percentile": 83.21, "90th_percentile": 83.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 67.61, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 67.61, "10th_percentile": 67.61, "90th_percentile": 67.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 52.01, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 52.01, "10th_percentile": 52.01, "90th_percentile": 52.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 33.28, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 33.28, "10th_percentile": 33.28, "90th_percentile": 33.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 88.41, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 88.41, "10th_percentile": 88.41, "90th_percentile": 88.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 104.01, "10th_percentile": 104.01, "90th_percentile": 104.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 85.29, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 85.29, "10th_percentile": 85.29, "90th_percentile": 85.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 60.64, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 60.64, "10th_percentile": 60.64, "90th_percentile": 60.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 36.72, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 36.72, "10th_percentile": 36.72, "90th_percentile": 36.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 41.6, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 41.6, "10th_percentile": 41.6, "90th_percentile": 41.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 41.6, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 41.6, "10th_percentile": 41.6, "90th_percentile": 41.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 104.01, "10th_percentile": 104.01, "90th_percentile": 104.01, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 104.01, "10th_percentile": 104.01, "90th_percentile": 104.01, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.01, "10th_percentile": 104.01, "90th_percentile": 104.01, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 104.01, "10th_percentile": 104.01, "90th_percentile": 104.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "2.7MM CORT SCR SELF-TAP SMALL HEX 42MM", "code_information": [ { "code": "SUP-353326", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 20.18, "maximum": 197.29, "setting": "outpatient", "gross_charge": 197.29, "discounted_cash": 138.1, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 53.27, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.67, "10th_percentile": 30.6, "90th_percentile": 50.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 28.08, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.67, "10th_percentile": 30.6, "90th_percentile": 50.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 53.27, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 53.27, "10th_percentile": 53.27, "90th_percentile": 53.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 98.65, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 98.65, "10th_percentile": 98.65, "90th_percentile": 98.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 52.01, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 75.33, "10th_percentile": 56.67, "90th_percentile": 93.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 98.65, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 75.33, "10th_percentile": 56.67, "90th_percentile": 93.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 46.17, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 46.17, "10th_percentile": 46.17, "90th_percentile": 46.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 138.1, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 138.1, "10th_percentile": 138.1, "90th_percentile": 138.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 114.43, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 88.78, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.79, "10th_percentile": 51.0, "90th_percentile": 84.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 46.8, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.79, "10th_percentile": 51.0, "90th_percentile": 84.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 88.78, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 88.78, "10th_percentile": 88.78, "90th_percentile": 88.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 88.78, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 88.78, "10th_percentile": 88.78, "90th_percentile": 88.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 24.23, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 67.4, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 31.2, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 60.43, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 20.18, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 83.21, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $104.01 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 104.01, "10th_percentile": 104.01, "90th_percentile": 104.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $104.01 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 83.21, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 83.21, "10th_percentile": 83.21, "90th_percentile": 83.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 67.61, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 67.61, "10th_percentile": 67.61, "90th_percentile": 67.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 52.01, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 52.01, "10th_percentile": 52.01, "90th_percentile": 52.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 33.28, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 33.28, "10th_percentile": 33.28, "90th_percentile": 33.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 88.41, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 88.41, "10th_percentile": 88.41, "90th_percentile": 88.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 104.01, "10th_percentile": 104.01, "90th_percentile": 104.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 85.29, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 85.29, "10th_percentile": 85.29, "90th_percentile": 85.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 60.64, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 60.64, "10th_percentile": 60.64, "90th_percentile": 60.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 36.72, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 36.72, "10th_percentile": 36.72, "90th_percentile": 36.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 41.6, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 41.6, "10th_percentile": 41.6, "90th_percentile": 41.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 41.6, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 41.6, "10th_percentile": 41.6, "90th_percentile": 41.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 104.01, "10th_percentile": 104.01, "90th_percentile": 104.01, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 104.01, "10th_percentile": 104.01, "90th_percentile": 104.01, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.01, "10th_percentile": 104.01, "90th_percentile": 104.01, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 104.01, "10th_percentile": 104.01, "90th_percentile": 104.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "2.7MM CORTICAL SCREW ST SMALL HEX 46MM", "code_information": [ { "code": "SUP-353522", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 20.18, "maximum": 197.29, "setting": "outpatient", "gross_charge": 197.29, "discounted_cash": 138.1, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 53.27, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.67, "10th_percentile": 30.6, "90th_percentile": 50.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 28.08, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.67, "10th_percentile": 30.6, "90th_percentile": 50.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 53.27, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 53.27, "10th_percentile": 53.27, "90th_percentile": 53.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 98.65, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 98.65, "10th_percentile": 98.65, "90th_percentile": 98.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 52.01, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 75.33, "10th_percentile": 56.67, "90th_percentile": 93.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 98.65, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 75.33, "10th_percentile": 56.67, "90th_percentile": 93.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 46.17, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 46.17, "10th_percentile": 46.17, "90th_percentile": 46.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 138.1, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 138.1, "10th_percentile": 138.1, "90th_percentile": 138.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 114.43, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 46.8, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.79, "10th_percentile": 51.0, "90th_percentile": 84.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 88.78, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.79, "10th_percentile": 51.0, "90th_percentile": 84.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 88.78, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 88.78, "10th_percentile": 88.78, "90th_percentile": 88.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 88.78, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 88.78, "10th_percentile": 88.78, "90th_percentile": 88.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.65, "10th_percentile": 113.34, "90th_percentile": 187.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 24.23, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 67.4, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 31.2, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 60.43, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 20.18, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 83.21, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $104.01 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 104.01, "10th_percentile": 104.01, "90th_percentile": 104.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $104.01 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 83.21, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 83.21, "10th_percentile": 83.21, "90th_percentile": 83.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 67.61, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 67.61, "10th_percentile": 67.61, "90th_percentile": 67.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 52.01, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 52.01, "10th_percentile": 52.01, "90th_percentile": 52.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 33.28, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 33.28, "10th_percentile": 33.28, "90th_percentile": 33.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 88.41, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 88.41, "10th_percentile": 88.41, "90th_percentile": 88.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 104.01, "10th_percentile": 104.01, "90th_percentile": 104.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 85.29, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 85.29, "10th_percentile": 85.29, "90th_percentile": 85.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 60.64, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 60.64, "10th_percentile": 60.64, "90th_percentile": 60.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 36.72, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 36.72, "10th_percentile": 36.72, "90th_percentile": 36.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 41.6, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 41.6, "10th_percentile": 41.6, "90th_percentile": 41.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 41.6, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 41.6, "10th_percentile": 41.6, "90th_percentile": 41.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 104.01, "10th_percentile": 104.01, "90th_percentile": 104.01, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 104.01, "10th_percentile": 104.01, "90th_percentile": 104.01, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.01, "10th_percentile": 104.01, "90th_percentile": 104.01, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 104.01, "10th_percentile": 104.01, "90th_percentile": 104.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "2.7MM METAPHYSEAL SCR SLF-TPNG W T8 STRDRV RECESS 10MM", "code_information": [ { "code": "SUP-377029", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 43.15, "maximum": 736.63, "setting": "outpatient", "gross_charge": 184.42, "discounted_cash": 129.09, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 49.79, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 89.84, "10th_percentile": 62.27, "90th_percentile": 187.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 80.99, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 89.84, "10th_percentile": 62.27, "90th_percentile": 187.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 89.84, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 89.84, "10th_percentile": 62.27, "90th_percentile": 187.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 170.41, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 89.84, "10th_percentile": 62.27, "90th_percentile": 187.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 198.89, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 89.84, "10th_percentile": 62.27, "90th_percentile": 187.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 49.79, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 170.41, "10th_percentile": 73.91, "90th_percentile": 193.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 170.41, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 170.41, "10th_percentile": 73.91, "90th_percentile": 193.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 198.89, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 170.41, "10th_percentile": 73.91, "90th_percentile": 193.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 315.58, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 341.95, "10th_percentile": 320.85, "90th_percentile": 363.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 368.32, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 341.95, "10th_percentile": 320.85, "90th_percentile": 363.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 166.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 315.58, "10th_percentile": 196.22, "90th_percentile": 357.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 315.58, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 315.58, "10th_percentile": 196.22, "90th_percentile": 357.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 368.32, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 315.58, "10th_percentile": 196.22, "90th_percentile": 357.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 43.15, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 147.69, "10th_percentile": 64.06, "90th_percentile": 167.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 147.69, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 147.69, "10th_percentile": 64.06, "90th_percentile": 167.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 172.37, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 147.69, "10th_percentile": 64.06, "90th_percentile": 167.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 515.64, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 478.73, "10th_percentile": 449.19, "90th_percentile": 508.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 441.81, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 478.73, "10th_percentile": 449.19, "90th_percentile": 508.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 366.07, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 396.66, "10th_percentile": 372.19, "90th_percentile": 421.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 427.25, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 396.66, "10th_percentile": 372.19, "90th_percentile": 421.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 149.74, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 284.02, "10th_percentile": 176.6, "90th_percentile": 321.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 284.02, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 284.02, "10th_percentile": 176.6, "90th_percentile": 321.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 331.48, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 284.02, "10th_percentile": 176.6, "90th_percentile": 321.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 284.02, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 307.75, "10th_percentile": 288.77, "90th_percentile": 326.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 331.48, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 307.75, "10th_percentile": 288.77, "90th_percentile": 326.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 331.48, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 307.75, "10th_percentile": 288.77, "90th_percentile": 326.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 284.02, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 307.75, "10th_percentile": 288.77, "90th_percentile": 326.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 299.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 332.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 631.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 736.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 631.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 683.89, "10th_percentile": 641.71, "90th_percentile": 726.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 736.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 683.89, "10th_percentile": 641.71, "90th_percentile": 726.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 736.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 631.16, "10th_percentile": 366.22, "90th_percentile": 715.54, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 631.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 631.16, "10th_percentile": 366.22, "90th_percentile": 715.54, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 299.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 631.16, "10th_percentile": 366.22, "90th_percentile": 715.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 736.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 631.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 332.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 299.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 736.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 631.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 332.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 299.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 299.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 332.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 631.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 736.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 736.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 631.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 332.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 299.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 736.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 631.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 332.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 299.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 736.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 631.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 332.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 299.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 481.95, "10th_percentile": 309.81, "90th_percentile": 704.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 77.53, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 215.62, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 99.83, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 193.33, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 64.55, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 266.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 332.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $332.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 332.75, "10th_percentile": 332.75, "90th_percentile": 332.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $332.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 266.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 266.2, "10th_percentile": 266.2, "90th_percentile": 266.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 216.29, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 216.29, "10th_percentile": 216.29, "90th_percentile": 216.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 166.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 166.38, "10th_percentile": 166.38, "90th_percentile": 166.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 106.48, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 106.48, "10th_percentile": 106.48, "90th_percentile": 106.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 282.84, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 282.84, "10th_percentile": 282.84, "90th_percentile": 282.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 332.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 332.75, "10th_percentile": 332.75, "90th_percentile": 332.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 272.86, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 272.86, "10th_percentile": 272.86, "90th_percentile": 272.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 193.99, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 193.99, "10th_percentile": 193.99, "90th_percentile": 193.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 117.46, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 117.46, "10th_percentile": 117.46, "90th_percentile": 117.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 133.1, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 133.1, "10th_percentile": 133.1, "90th_percentile": 133.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 133.1, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 133.1, "10th_percentile": 133.1, "90th_percentile": 133.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 332.75, "10th_percentile": 332.75, "90th_percentile": 332.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 332.75, "10th_percentile": 332.75, "90th_percentile": 332.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 332.75, "10th_percentile": 332.75, "90th_percentile": 332.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 332.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 332.75, "10th_percentile": 332.75, "90th_percentile": 332.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "21GA X 15CM NEEDLE PERC ENTRY ECHOTP W/O BASEPLT", "code_information": [ { "code": "SUP-150868", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 1.62, "maximum": 34.58, "setting": "outpatient", "gross_charge": 12.41, "discounted_cash": 8.69, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 12.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 25.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 28.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 34.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 12.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 25.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 28.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 28.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 25.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 12.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 34.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 28.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 25.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 12.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 12.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 25.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 28.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 34.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 12.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 25.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 28.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 34.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 34.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 26.88, "10th_percentile": 21.71, "90th_percentile": 32.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 28.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 26.88, "10th_percentile": 21.71, "90th_percentile": 32.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 25.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 26.88, "10th_percentile": 21.71, "90th_percentile": 32.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 26.88, "10th_percentile": 21.71, "90th_percentile": 32.73, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 34.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 25.34, "10th_percentile": 15.51, "90th_percentile": 32.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 28.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 25.34, "10th_percentile": 15.51, "90th_percentile": 32.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 25.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 25.34, "10th_percentile": 15.51, "90th_percentile": 32.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 25.34, "10th_percentile": 15.51, "90th_percentile": 32.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 12.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 25.34, "10th_percentile": 15.51, "90th_percentile": 32.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 12.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 13.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 20.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 25.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 28.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 34.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 22.74, "10th_percentile": 12.88, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 9.07, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.09, "10th_percentile": 9.77, "90th_percentile": 14.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 11.4, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.09, "10th_percentile": 9.77, "90th_percentile": 14.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 12.79, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.09, "10th_percentile": 9.77, "90th_percentile": 14.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 15.56, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.09, "10th_percentile": 9.77, "90th_percentile": 14.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 15.56, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.09, "10th_percentile": 9.77, "90th_percentile": 14.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 12.79, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.09, "10th_percentile": 9.77, "90th_percentile": 14.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 11.4, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.09, "10th_percentile": 9.77, "90th_percentile": 14.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 9.07, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.09, "10th_percentile": 9.77, "90th_percentile": 14.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 15.56, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.4, "10th_percentile": 7.23, "90th_percentile": 14.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 12.79, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.4, "10th_percentile": 7.23, "90th_percentile": 14.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 11.4, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.4, "10th_percentile": 7.23, "90th_percentile": 14.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 9.07, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.4, "10th_percentile": 7.23, "90th_percentile": 14.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 6.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.4, "10th_percentile": 7.23, "90th_percentile": 14.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 9.34, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.44, "10th_percentile": 2.76, "90th_percentile": 8.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 7.67, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.44, "10th_percentile": 2.76, "90th_percentile": 8.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 6.84, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.44, "10th_percentile": 2.76, "90th_percentile": 8.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 5.44, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.44, "10th_percentile": 2.76, "90th_percentile": 8.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3.61, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.44, "10th_percentile": 2.76, "90th_percentile": 8.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3.35, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.44, "10th_percentile": 2.76, "90th_percentile": 8.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.87, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.44, "10th_percentile": 2.76, "90th_percentile": 8.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.87, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.84, "10th_percentile": 3.3, "90th_percentile": 8.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 5.44, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.84, "10th_percentile": 3.3, "90th_percentile": 8.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 6.84, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.84, "10th_percentile": 3.3, "90th_percentile": 8.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 7.67, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.84, "10th_percentile": 3.3, "90th_percentile": 8.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 9.34, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.84, "10th_percentile": 3.3, "90th_percentile": 8.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 17.29, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 13.44, "10th_percentile": 10.86, "90th_percentile": 16.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 14.21, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 13.44, "10th_percentile": 10.86, "90th_percentile": 16.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 12.67, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 13.44, "10th_percentile": 10.86, "90th_percentile": 16.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 10.08, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 13.44, "10th_percentile": 10.86, "90th_percentile": 16.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 6.68, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 12.67, "10th_percentile": 8.04, "90th_percentile": 16.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 10.08, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 12.67, "10th_percentile": 8.04, "90th_percentile": 16.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 12.67, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 12.67, "10th_percentile": 8.04, "90th_percentile": 16.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 14.21, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 12.67, "10th_percentile": 8.04, "90th_percentile": 16.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 17.29, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 12.67, "10th_percentile": 8.04, "90th_percentile": 16.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1.62, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 5.93, "10th_percentile": 2.86, "90th_percentile": 7.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 4.72, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 5.93, "10th_percentile": 2.86, "90th_percentile": 7.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 5.93, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 5.93, "10th_percentile": 2.86, "90th_percentile": 7.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 6.65, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 5.93, "10th_percentile": 2.86, "90th_percentile": 7.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 8.09, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 5.93, "10th_percentile": 2.86, "90th_percentile": 7.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 20.06, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 15.59, "10th_percentile": 12.59, "90th_percentile": 18.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 16.48, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 15.59, "10th_percentile": 12.59, "90th_percentile": 18.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 14.7, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 15.59, "10th_percentile": 12.59, "90th_percentile": 18.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 11.69, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 15.59, "10th_percentile": 12.59, "90th_percentile": 18.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 14.11, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 18.81, "10th_percentile": 15.2, "90th_percentile": 22.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 17.74, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 18.81, "10th_percentile": 15.2, "90th_percentile": 22.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 19.89, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 18.81, "10th_percentile": 15.2, "90th_percentile": 22.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 24.21, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 18.81, "10th_percentile": 15.2, "90th_percentile": 22.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 5.34, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 5.34, "10th_percentile": 5.34, "90th_percentile": 5.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 5.34, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 5.34, "10th_percentile": 5.34, "90th_percentile": 5.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 4.72, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 4.72, "10th_percentile": 4.72, "90th_percentile": 4.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 10.96, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 10.96, "10th_percentile": 10.96, "90th_percentile": 10.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 4.01, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 4.01, "10th_percentile": 4.01, "90th_percentile": 4.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 6.68, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 6.68, "10th_percentile": 6.68, "90th_percentile": 6.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 7.79, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.79, "10th_percentile": 7.79, "90th_percentile": 7.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 4.28, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.28, "10th_percentile": 4.28, "90th_percentile": 4.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 8.66, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.66, "10th_percentile": 8.66, "90th_percentile": 8.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 7.76, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.76, "10th_percentile": 7.76, "90th_percentile": 7.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 2.59, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 2.59, "10th_percentile": 2.59, "90th_percentile": 2.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 13.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 13.36, "10th_percentile": 13.36, "90th_percentile": 13.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 11.36, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 11.36, "10th_percentile": 11.36, "90th_percentile": 11.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 8.68, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 8.68, "10th_percentile": 8.68, "90th_percentile": 8.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 10.69, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 10.69, "10th_percentile": 10.69, "90th_percentile": 10.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 13.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $13.36 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 13.36, "10th_percentile": 13.36, "90th_percentile": 13.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $13.36 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.36, "10th_percentile": 13.36, "90th_percentile": 13.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 3.11, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.11, "10th_percentile": 3.11, "90th_percentile": 3.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 10.69, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 10.69, "10th_percentile": 10.69, "90th_percentile": 10.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.36, "10th_percentile": 13.36, "90th_percentile": 13.36, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 13.36, "10th_percentile": 13.36, "90th_percentile": 13.36, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 13.36, "10th_percentile": 13.36, "90th_percentile": 13.36, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" } ] } ] }, { "description": "25G ILLUMINATED CURVED LASER PROBE", "code_information": [ { "code": "SUP-165158", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 121.22, "maximum": 3270.91, "setting": "outpatient", "gross_charge": 928.47, "discounted_cash": 649.93, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 928.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 999.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1896.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3270.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 928.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 999.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1896.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3270.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 928.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 999.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1896.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3270.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 928.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 999.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1896.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3270.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3270.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1896.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 999.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 928.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 928.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 999.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1896.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3270.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1896.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2583.78, "10th_percentile": 2034.08, "90th_percentile": 3133.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3270.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2583.78, "10th_percentile": 2034.08, "90th_percentile": 3133.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3270.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1896.65, "10th_percentile": 1122.11, "90th_percentile": 2996.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1896.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1896.65, "10th_percentile": 1122.11, "90th_percentile": 2996.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 928.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1896.65, "10th_percentile": 1122.11, "90th_percentile": 2996.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 928.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 999.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1896.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 3270.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1448.28, "10th_percentile": 949.9, "90th_percentile": 2858.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 1471.91, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1162.7, "10th_percentile": 915.33, "90th_percentile": 1410.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 853.49, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1162.7, "10th_percentile": 915.33, "90th_percentile": 1410.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 853.49, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1162.7, "10th_percentile": 915.33, "90th_percentile": 1410.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1471.91, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1162.7, "10th_percentile": 915.33, "90th_percentile": 1410.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1471.91, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 853.49, "10th_percentile": 530.67, "90th_percentile": 1348.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 853.49, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 853.49, "10th_percentile": 530.67, "90th_percentile": 1348.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 449.96, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 853.49, "10th_percentile": 530.67, "90th_percentile": 1348.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 139.87, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 269.98, "10th_percentile": 184.2, "90th_percentile": 734.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 250.69, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 269.98, "10th_percentile": 184.2, "90th_percentile": 734.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 269.98, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 269.98, "10th_percentile": 184.2, "90th_percentile": 734.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 512.1, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 269.98, "10th_percentile": 184.2, "90th_percentile": 734.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 883.15, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 269.98, "10th_percentile": 184.2, "90th_percentile": 734.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 139.87, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 512.1, "10th_percentile": 214.32, "90th_percentile": 808.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 512.1, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 512.1, "10th_percentile": 214.32, "90th_percentile": 808.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 883.15, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 512.1, "10th_percentile": 214.32, "90th_percentile": 808.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1635.46, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1291.89, "10th_percentile": 1017.04, "90th_percentile": 1566.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 948.33, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1291.89, "10th_percentile": 1017.04, "90th_percentile": 1566.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 499.96, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 948.33, "10th_percentile": 589.63, "90th_percentile": 1498.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 948.33, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 948.33, "10th_percentile": 589.63, "90th_percentile": 1498.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1635.46, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 948.33, "10th_percentile": 589.63, "90th_percentile": 1498.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 121.22, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 443.82, "10th_percentile": 133.47, "90th_percentile": 765.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 151.84, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 443.82, "10th_percentile": 133.47, "90th_percentile": 765.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 443.82, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 443.82, "10th_percentile": 133.47, "90th_percentile": 765.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 765.39, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 443.82, "10th_percentile": 133.47, "90th_percentile": 765.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 765.39, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 443.82, "10th_percentile": 133.47, "90th_percentile": 765.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC SEIU HEALTHLINK", "standard_charge_dollar": 356.9, "standard_charge_percentage": 55.0, "standard_charge_algorithm": "All Services; 55% Billed", "median_amount": 1077.95, "10th_percentile": 501.11, "90th_percentile": 1654.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 55% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC SEIU HEALTHLINK", "standard_charge_dollar": 1799.0, "standard_charge_percentage": 55.0, "standard_charge_algorithm": "All Services; 55% Billed", "median_amount": 1077.95, "10th_percentile": 501.11, "90th_percentile": 1654.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 55% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1100.06, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1498.6, "10th_percentile": 1179.77, "90th_percentile": 1817.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1897.13, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1498.6, "10th_percentile": 1179.77, "90th_percentile": 1817.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1327.66, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1808.65, "10th_percentile": 1423.86, "90th_percentile": 2193.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 2289.64, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1808.65, "10th_percentile": 1423.86, "90th_percentile": 2193.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 399.96, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 399.96, "10th_percentile": 399.96, "90th_percentile": 399.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 399.96, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 399.96, "10th_percentile": 399.96, "90th_percentile": 399.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 352.97, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 352.97, "10th_percentile": 352.97, "90th_percentile": 352.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 819.93, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 819.93, "10th_percentile": 819.93, "90th_percentile": 819.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 299.97, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 299.97, "10th_percentile": 299.97, "90th_percentile": 299.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 499.96, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 499.96, "10th_percentile": 499.96, "90th_percentile": 499.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 582.95, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 582.95, "10th_percentile": 582.95, "90th_percentile": 582.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 319.97, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 319.97, "10th_percentile": 319.97, "90th_percentile": 319.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 647.94, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 647.94, "10th_percentile": 647.94, "90th_percentile": 647.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 580.95, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 580.95, "10th_percentile": 580.95, "90th_percentile": 580.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 193.98, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 193.98, "10th_percentile": 193.98, "90th_percentile": 193.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 999.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 999.91, "10th_percentile": 999.91, "90th_percentile": 999.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 849.92, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 849.92, "10th_percentile": 849.92, "90th_percentile": 849.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 649.94, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 649.94, "10th_percentile": 649.94, "90th_percentile": 649.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 799.93, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 799.93, "10th_percentile": 799.93, "90th_percentile": 799.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 999.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $999.91 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 999.91, "10th_percentile": 999.91, "90th_percentile": 999.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $999.91 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 999.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 999.91, "10th_percentile": 999.91, "90th_percentile": 999.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 232.98, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 232.98, "10th_percentile": 232.98, "90th_percentile": 232.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 799.93, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 799.93, "10th_percentile": 799.93, "90th_percentile": 799.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 999.91, "10th_percentile": 999.91, "90th_percentile": 999.91, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 999.91, "10th_percentile": 999.91, "90th_percentile": 999.91, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 999.91, "10th_percentile": 999.91, "90th_percentile": 999.91, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" } ] } ] }, { "description": "25G RETROBULBAR NEEDLE", "code_information": [ { "code": "SUP-348208", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 2.32, "maximum": 17.54, "setting": "outpatient", "gross_charge": 8.59, "discounted_cash": 6.01, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.59, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.06, "10th_percentile": 9.49, "90th_percentile": 16.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.06, "10th_percentile": 9.49, "90th_percentile": 16.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.06, "10th_percentile": 9.49, "90th_percentile": 16.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.59, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.06, "10th_percentile": 9.49, "90th_percentile": 16.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.59, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.06, "10th_percentile": 9.49, "90th_percentile": 16.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.06, "10th_percentile": 9.49, "90th_percentile": 16.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.59, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.06, "10th_percentile": 9.49, "90th_percentile": 16.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.06, "10th_percentile": 9.49, "90th_percentile": 16.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.59, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.06, "10th_percentile": 9.49, "90th_percentile": 16.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.06, "10th_percentile": 9.49, "90th_percentile": 16.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.59, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.06, "10th_percentile": 9.49, "90th_percentile": 16.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.06, "10th_percentile": 9.49, "90th_percentile": 16.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 17.54, "10th_percentile": 17.54, "90th_percentile": 17.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.59, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.06, "10th_percentile": 9.49, "90th_percentile": 16.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.06, "10th_percentile": 9.49, "90th_percentile": 16.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 8.59, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 13.06, "10th_percentile": 9.49, "90th_percentile": 16.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 17.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 13.06, "10th_percentile": 9.49, "90th_percentile": 16.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 7.89, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.89, "10th_percentile": 7.89, "90th_percentile": 7.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 7.89, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.89, "10th_percentile": 7.89, "90th_percentile": 7.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 7.89, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.89, "10th_percentile": 7.89, "90th_percentile": 7.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2.32, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.53, "10th_percentile": 2.56, "90th_percentile": 4.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 4.74, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.53, "10th_percentile": 2.56, "90th_percentile": 4.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 4.74, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.74, "10th_percentile": 4.74, "90th_percentile": 4.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 8.77, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 8.77, "10th_percentile": 8.77, "90th_percentile": 8.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 8.77, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 8.77, "10th_percentile": 8.77, "90th_percentile": 8.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 4.1, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 4.1, "10th_percentile": 4.1, "90th_percentile": 4.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 10.17, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 10.17, "10th_percentile": 10.17, "90th_percentile": 10.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 12.28, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% 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 Outpatient Services; 70% Billed" } ] } ] }, { "description": "25MM X10 CROSSLINK FIXED", "code_information": [ { "code": "SUP-106299", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 340.79, "maximum": 3332.07, "setting": "outpatient", "gross_charge": 3332.07, "discounted_cash": 2332.45, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 899.66, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 474.3, "10th_percentile": 447.19, "90th_percentile": 814.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 474.3, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 474.3, "10th_percentile": 447.19, "90th_percentile": 814.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 440.41, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 474.3, "10th_percentile": 447.19, "90th_percentile": 814.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 899.66, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 899.66, "10th_percentile": 899.66, "90th_percentile": 899.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1666.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1666.04, "10th_percentile": 1666.04, "90th_percentile": 1666.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1666.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1272.18, "10th_percentile": 957.1, "90th_percentile": 1587.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 878.33, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1272.18, "10th_percentile": 957.1, "90th_percentile": 1587.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1932.6, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1932.6, "10th_percentile": 1932.6, "90th_percentile": 1932.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 2332.45, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 2332.45, "10th_percentile": 2332.45, "90th_percentile": 2332.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1499.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1499.43, "10th_percentile": 1499.43, "90th_percentile": 1499.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 790.5, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1144.97, "10th_percentile": 861.39, "90th_percentile": 1428.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1499.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1144.97, "10th_percentile": 861.39, "90th_percentile": 1428.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 1499.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1499.43, "10th_percentile": 1499.43, "90th_percentile": 1499.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1631.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1756.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1631.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2481.61, "10th_percentile": 1801.24, "90th_percentile": 3161.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2481.61, "10th_percentile": 1801.24, "90th_percentile": 3161.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1756.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1631.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1756.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1631.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1631.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1756.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1756.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1631.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1756.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1631.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1631.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1756.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 409.3, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 1138.32, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 527.0, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 1020.62, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 340.79, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1756.66, "10th_percentile": 1756.66, "90th_percentile": 1756.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 1756.66, "10th_percentile": 1756.66, "90th_percentile": 1756.66, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 1756.66, "10th_percentile": 1756.66, "90th_percentile": 1756.66, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 1405.33, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 1756.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,756.66 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1756.66, "10th_percentile": 1756.66, "90th_percentile": 1756.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,756.66 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1756.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1756.66, "90th_percentile": 1756.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 1405.33, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 1405.33, "10th_percentile": 1405.33, "90th_percentile": 1405.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1141.83, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 1141.83, "10th_percentile": 1141.83, "90th_percentile": 1141.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 878.33, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 878.33, "10th_percentile": 878.33, "90th_percentile": 878.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 562.13, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 562.13, "10th_percentile": 562.13, "90th_percentile": 562.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 1493.16, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 1493.16, "10th_percentile": 1493.16, "90th_percentile": 1493.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1756.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1756.66, "90th_percentile": 1756.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 1440.46, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 1440.46, "10th_percentile": 1440.46, "90th_percentile": 1440.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 1024.13, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1024.13, "10th_percentile": 1024.13, "90th_percentile": 1024.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 620.1, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 620.1, "10th_percentile": 620.1, "90th_percentile": 620.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 702.66, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 702.66, "10th_percentile": 702.66, "90th_percentile": 702.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 702.66, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 702.66, "10th_percentile": 702.66, "90th_percentile": 702.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" } ] } ] }, { "description": "2MM MATCHSTICK BURR", "code_information": [ { "code": "SUP-162182", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 108.97, "maximum": 2136.38, "setting": "outpatient", "gross_charge": 521.58, "discounted_cash": 365.11, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 521.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 561.72, "10th_percentile": 529.61, "90th_percentile": 1821.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 561.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 561.72, "10th_percentile": 529.61, "90th_percentile": 1821.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2136.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 561.72, "10th_percentile": 529.61, "90th_percentile": 1821.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2136.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 561.72, "10th_percentile": 529.61, "90th_percentile": 1821.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 561.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 561.72, "10th_percentile": 529.61, "90th_percentile": 1821.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 521.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 561.72, "10th_percentile": 529.61, "90th_percentile": 1821.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 521.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 561.72, "10th_percentile": 529.61, "90th_percentile": 1821.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 561.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 561.72, "10th_percentile": 529.61, "90th_percentile": 1821.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2136.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 561.72, "10th_percentile": 529.61, "90th_percentile": 1821.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 521.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 561.72, "10th_percentile": 529.61, "90th_percentile": 1821.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 561.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 561.72, "10th_percentile": 529.61, "90th_percentile": 1821.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2136.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 561.72, "10th_percentile": 529.61, "90th_percentile": 1821.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2136.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 561.72, "10th_percentile": 529.61, "90th_percentile": 1821.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 561.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 561.72, "10th_percentile": 529.61, "90th_percentile": 1821.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 521.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 561.72, "10th_percentile": 529.61, "90th_percentile": 1821.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2136.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 561.72, "10th_percentile": 529.61, "90th_percentile": 1821.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 561.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 561.72, "10th_percentile": 529.61, "90th_percentile": 1821.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 521.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 561.72, "10th_percentile": 529.61, "90th_percentile": 1821.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2136.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2136.38, "10th_percentile": 2136.38, "90th_percentile": 2136.38, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 521.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1328.98, "10th_percentile": 683.06, "90th_percentile": 1974.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2136.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1328.98, "10th_percentile": 683.06, "90th_percentile": 1974.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2136.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 561.72, "10th_percentile": 529.61, "90th_percentile": 1821.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 561.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 561.72, "10th_percentile": 529.61, "90th_percentile": 1821.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 521.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 561.72, "10th_percentile": 529.61, "90th_percentile": 1821.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 961.37, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 961.37, "10th_percentile": 961.37, "90th_percentile": 961.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 961.37, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 961.37, "10th_percentile": 961.37, "90th_percentile": 961.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 252.77, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 607.07, "10th_percentile": 323.63, "90th_percentile": 890.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 961.37, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 607.07, "10th_percentile": 323.63, "90th_percentile": 890.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 140.83, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 151.66, "10th_percentile": 143.0, "90th_percentile": 491.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 151.66, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 151.66, "10th_percentile": 143.0, "90th_percentile": 491.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 576.82, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 151.66, "10th_percentile": 143.0, "90th_percentile": 491.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 576.82, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 576.82, "10th_percentile": 576.82, "90th_percentile": 576.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1068.19, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1068.19, "10th_percentile": 1068.19, "90th_percentile": 1068.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 280.86, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 674.53, "10th_percentile": 359.59, "90th_percentile": 989.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1068.19, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 674.53, "10th_percentile": 359.59, "90th_percentile": 989.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 499.91, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 499.91, "10th_percentile": 499.91, "90th_percentile": 499.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1239.1, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1239.1, "10th_percentile": 1239.1, "90th_percentile": 1239.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1495.47, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1495.47, "10th_percentile": 1495.47, "90th_percentile": 1495.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 224.69, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 224.69, "10th_percentile": 224.69, "90th_percentile": 224.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 224.69, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 224.69, "10th_percentile": 224.69, "90th_percentile": 224.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 198.29, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 198.29, "10th_percentile": 198.29, "90th_percentile": 198.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 460.61, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 460.61, "10th_percentile": 460.61, "90th_percentile": 460.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 168.52, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 168.52, "10th_percentile": 168.52, "90th_percentile": 168.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 280.86, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 280.86, "10th_percentile": 280.86, "90th_percentile": 280.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 327.48, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 327.48, "10th_percentile": 327.48, "90th_percentile": 327.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 179.75, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 363.99, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 363.99, "10th_percentile": 363.99, "90th_percentile": 363.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 326.36, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 326.36, "10th_percentile": 326.36, "90th_percentile": 326.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 108.97, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 108.97, "10th_percentile": 108.97, "90th_percentile": 108.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 561.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 561.72, "10th_percentile": 561.72, "90th_percentile": 561.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 477.46, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 477.46, "10th_percentile": 477.46, "90th_percentile": 477.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 365.12, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 365.12, "10th_percentile": 365.12, "90th_percentile": 365.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 449.38, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 449.38, "10th_percentile": 449.38, "90th_percentile": 449.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 561.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $561.72 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 561.72, "10th_percentile": 561.72, "90th_percentile": 561.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $561.72 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 561.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 561.72, "10th_percentile": 561.72, "90th_percentile": 561.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 130.88, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 130.88, "10th_percentile": 130.88, "90th_percentile": 130.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 449.38, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 449.38, "10th_percentile": 449.38, "90th_percentile": 449.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 561.72, "10th_percentile": 561.72, "90th_percentile": 561.72, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 561.72, "10th_percentile": 561.72, "90th_percentile": 561.72, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 561.72, "10th_percentile": 561.72, "90th_percentile": 561.72, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" } ] } ] }, { "description": "3.0MM X 170MM THREADED PIN", "code_information": [ { "code": "SUP-345128", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 44.84, "maximum": 1054.91, "setting": "outpatient", "gross_charge": 214.63, "discounted_cash": 150.24, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 57.95, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 90.39, "10th_percentile": 59.29, "90th_percentile": 234.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 62.41, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 90.39, "10th_percentile": 59.29, "90th_percentile": 234.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 118.38, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 90.39, "10th_percentile": 59.29, "90th_percentile": 234.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 284.83, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 90.39, "10th_percentile": 59.29, "90th_percentile": 234.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 118.38, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 201.6, "10th_percentile": 135.03, "90th_percentile": 268.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 284.83, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 201.6, "10th_percentile": 135.03, "90th_percentile": 268.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 219.22, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 373.34, "10th_percentile": 250.04, "90th_percentile": 496.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 527.46, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 373.34, "10th_percentile": 250.04, "90th_percentile": 496.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 219.22, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 219.22, "10th_percentile": 136.3, "90th_percentile": 465.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 527.46, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 219.22, "10th_percentile": 136.3, "90th_percentile": 465.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 115.57, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 219.22, "10th_percentile": 136.3, "90th_percentile": 465.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 102.59, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 246.85, "10th_percentile": 131.44, "90th_percentile": 246.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 246.85, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 246.85, "10th_percentile": 131.44, "90th_percentile": 246.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 246.85, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 246.85, "10th_percentile": 131.44, "90th_percentile": 246.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC SEIU HEALTHLINK", "standard_charge_dollar": 580.2, "standard_charge_percentage": 55.0, "standard_charge_algorithm": "All Services; 55% Billed", "median_amount": 580.2, "10th_percentile": 580.2, "90th_percentile": 580.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 55% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 306.9, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 522.67, "10th_percentile": 350.05, "90th_percentile": 695.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 738.44, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 522.67, "10th_percentile": 350.05, "90th_percentile": 695.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 611.85, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 433.07, "10th_percentile": 290.05, "90th_percentile": 576.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 254.29, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 433.07, "10th_percentile": 290.05, "90th_percentile": 576.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 197.29, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 197.29, "10th_percentile": 122.67, "90th_percentile": 419.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 474.71, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 197.29, "10th_percentile": 122.67, "90th_percentile": 419.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 104.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 197.29, "10th_percentile": 122.67, "90th_percentile": 419.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 197.29, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 336.0, "10th_percentile": 225.03, "90th_percentile": 446.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 474.71, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 336.0, "10th_percentile": 225.03, "90th_percentile": 446.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 197.29, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 336.0, "10th_percentile": 225.03, "90th_percentile": 446.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 474.71, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 336.0, "10th_percentile": 225.03, "90th_percentile": 446.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 438.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1054.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 438.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 746.67, "10th_percentile": 500.08, "90th_percentile": 993.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1054.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 746.67, "10th_percentile": 500.08, "90th_percentile": 993.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1054.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 438.43, "10th_percentile": 259.39, "90th_percentile": 931.61, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 438.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 438.43, "10th_percentile": 259.39, "90th_percentile": 931.61, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 438.43, "10th_percentile": 259.39, "90th_percentile": 931.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 438.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1054.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1054.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 438.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 438.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1054.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 438.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1054.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1054.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 438.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1054.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 438.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 334.78, "10th_percentile": 219.58, "90th_percentile": 869.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 53.86, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 149.78, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 69.34, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 134.29, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 44.84, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 184.91, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $231.14 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $231.14 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 184.91, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 184.91, "10th_percentile": 184.91, "90th_percentile": 184.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 150.24, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 150.24, "10th_percentile": 150.24, "90th_percentile": 150.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 115.57, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 115.57, "10th_percentile": 115.57, "90th_percentile": 115.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 73.96, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 73.96, "10th_percentile": 73.96, "90th_percentile": 73.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 196.47, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 196.47, "10th_percentile": 196.47, "90th_percentile": 196.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 189.53, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 189.53, "10th_percentile": 189.53, "90th_percentile": 189.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 134.75, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.75, "10th_percentile": 134.75, "90th_percentile": 134.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 81.59, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 81.59, "10th_percentile": 81.59, "90th_percentile": 81.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 92.46, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 92.46, "10th_percentile": 92.46, "90th_percentile": 92.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 92.46, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 92.46, "10th_percentile": 92.46, "90th_percentile": 92.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "3.2MM TITANIUM ROD 240MM", "code_information": [ { "code": "SUP-58639", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 106.5, "maximum": 2302.28, "setting": "outpatient", "gross_charge": 2302.28, "discounted_cash": 1611.6, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 621.62, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 214.68, "10th_percentile": 138.0, "90th_percentile": 519.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 148.22, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 214.68, "10th_percentile": 138.0, "90th_percentile": 519.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 133.62, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 214.68, "10th_percentile": 138.0, "90th_percentile": 519.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 281.14, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 214.68, "10th_percentile": 138.0, "90th_percentile": 519.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 281.14, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 451.38, "10th_percentile": 315.19, "90th_percentile": 587.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 621.62, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 451.38, "10th_percentile": 315.19, "90th_percentile": 587.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1151.14, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 835.89, "10th_percentile": 583.69, "90th_percentile": 1088.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 520.64, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 835.89, "10th_percentile": 583.69, "90th_percentile": 1088.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 274.48, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 520.64, "10th_percentile": 323.71, "90th_percentile": 1025.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 520.64, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 520.64, "10th_percentile": 323.71, "90th_percentile": 1025.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1151.14, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 520.64, "10th_percentile": 323.71, "90th_percentile": 1025.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 538.73, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 538.73, "10th_percentile": 302.67, "90th_percentile": 538.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 538.73, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 538.73, "10th_percentile": 302.67, "90th_percentile": 538.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 243.66, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 538.73, "10th_percentile": 302.67, "90th_percentile": 538.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC SEIU HEALTHLINK", "standard_charge_dollar": 1266.25, "standard_charge_percentage": 55.0, "standard_charge_algorithm": "All Services; 55% Billed", "median_amount": 1266.25, "10th_percentile": 1266.25, "90th_percentile": 1266.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 55% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 728.89, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1170.24, "10th_percentile": 817.16, "90th_percentile": 1523.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1611.6, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1170.24, "10th_percentile": 817.16, "90th_percentile": 1523.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1335.32, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 969.63, "10th_percentile": 677.08, "90th_percentile": 1262.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 603.94, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 969.63, "10th_percentile": 677.08, "90th_percentile": 1262.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 247.03, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 468.57, "10th_percentile": 291.34, "90th_percentile": 922.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 468.57, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 468.57, "10th_percentile": 291.34, "90th_percentile": 922.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1036.03, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 468.57, "10th_percentile": 291.34, "90th_percentile": 922.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 468.57, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 752.3, "10th_percentile": 525.32, "90th_percentile": 979.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1036.03, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 752.3, "10th_percentile": 525.32, "90th_percentile": 979.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 468.57, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 752.3, "10th_percentile": 525.32, "90th_percentile": 979.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 1036.03, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 752.3, "10th_percentile": 525.32, "90th_percentile": 979.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1041.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 494.89, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 548.96, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2302.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1041.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1671.78, "10th_percentile": 1167.37, "90th_percentile": 2176.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2302.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1671.78, "10th_percentile": 1167.37, "90th_percentile": 2176.18, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1041.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1041.27, "10th_percentile": 604.17, "90th_percentile": 2050.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 494.89, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1041.27, "10th_percentile": 604.17, "90th_percentile": 2050.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2302.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1041.27, "10th_percentile": 604.17, "90th_percentile": 2050.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 494.89, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 548.96, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1041.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2302.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1041.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 494.89, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 548.96, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2302.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1041.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 494.89, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 548.96, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2302.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1041.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2302.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 548.96, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 494.89, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1041.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2302.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 548.96, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 494.89, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 494.89, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 548.96, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1041.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2302.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 795.12, "10th_percentile": 511.11, "90th_percentile": 1923.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 127.91, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 355.73, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 164.69, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 318.95, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 106.5, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 439.17, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 548.96, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $548.96 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 548.96, "10th_percentile": 548.96, "90th_percentile": 548.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $548.96 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 439.17, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 439.17, "10th_percentile": 439.17, "90th_percentile": 439.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 356.82, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 356.82, "10th_percentile": 356.82, "90th_percentile": 356.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 274.48, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 274.48, "10th_percentile": 274.48, "90th_percentile": 274.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 175.67, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 175.67, "10th_percentile": 175.67, "90th_percentile": 175.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 466.62, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 466.62, "10th_percentile": 466.62, "90th_percentile": 466.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 548.96, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 548.96, "10th_percentile": 548.96, "90th_percentile": 548.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 450.15, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 450.15, "10th_percentile": 450.15, "90th_percentile": 450.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 320.04, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 320.04, "10th_percentile": 320.04, "90th_percentile": 320.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 193.78, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 193.78, "10th_percentile": 193.78, "90th_percentile": 193.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 219.58, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 219.58, "10th_percentile": 219.58, "90th_percentile": 219.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 219.58, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 219.58, "10th_percentile": 219.58, "90th_percentile": 219.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 548.96, "10th_percentile": 548.96, "90th_percentile": 548.96, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 548.96, "10th_percentile": 548.96, "90th_percentile": 548.96, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 548.96, "10th_percentile": 548.96, "90th_percentile": 548.96, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 548.96, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 548.96, "10th_percentile": 548.96, "90th_percentile": 548.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "3.5MM CANN SCR FULL THD 30MM", "code_information": [ { "code": "SUP-353220", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 157.84, "maximum": 1543.27, "setting": "outpatient", "gross_charge": 1543.27, "discounted_cash": 1080.29, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 416.68, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 318.18, "10th_percentile": 239.37, "90th_percentile": 396.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 219.67, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 318.18, "10th_percentile": 239.37, "90th_percentile": 396.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 416.68, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 416.68, "10th_percentile": 416.68, "90th_percentile": 416.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 771.64, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 771.64, "10th_percentile": 771.64, "90th_percentile": 771.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 771.64, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 589.23, "10th_percentile": 443.29, "90th_percentile": 735.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 406.81, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 589.23, "10th_percentile": 443.29, "90th_percentile": 735.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 361.13, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 361.13, "10th_percentile": 361.13, "90th_percentile": 361.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1080.29, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1080.29, "10th_percentile": 1080.29, "90th_percentile": 1080.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 895.1, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 895.1, "10th_percentile": 895.1, "90th_percentile": 895.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 694.47, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 530.3, "10th_percentile": 398.96, "90th_percentile": 661.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 366.12, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 530.3, "10th_percentile": 398.96, "90th_percentile": 661.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 694.47, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 694.47, "10th_percentile": 694.47, "90th_percentile": 694.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 694.47, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 694.47, "10th_percentile": 694.47, "90th_percentile": 694.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 189.57, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 527.22, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 244.08, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 472.71, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 157.84, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 650.89, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $813.61 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $813.61 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 650.89, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 650.89, "10th_percentile": 650.89, "90th_percentile": 650.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 528.85, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 528.85, "10th_percentile": 528.85, "90th_percentile": 528.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 406.81, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 406.81, "10th_percentile": 406.81, "90th_percentile": 406.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 260.36, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 260.36, "10th_percentile": 260.36, "90th_percentile": 260.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 691.57, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 691.57, "10th_percentile": 691.57, "90th_percentile": 691.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 667.16, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 667.16, "10th_percentile": 667.16, "90th_percentile": 667.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 474.33, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 474.33, "10th_percentile": 474.33, "90th_percentile": 474.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 287.2, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 287.2, "10th_percentile": 287.2, "90th_percentile": 287.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 325.44, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 325.44, "10th_percentile": 325.44, "90th_percentile": 325.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 325.44, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 325.44, "10th_percentile": 325.44, "90th_percentile": 325.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "3.5MM CANN SCR FULL THD 34MM", "code_information": [ { "code": "SUP-353224", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 157.84, "maximum": 1543.27, "setting": "outpatient", "gross_charge": 1543.27, "discounted_cash": 1080.29, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 416.68, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 318.18, "10th_percentile": 239.37, "90th_percentile": 396.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 219.67, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 318.18, "10th_percentile": 239.37, "90th_percentile": 396.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 416.68, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 416.68, "10th_percentile": 416.68, "90th_percentile": 416.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 771.64, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 771.64, "10th_percentile": 771.64, "90th_percentile": 771.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 771.64, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 589.23, "10th_percentile": 443.29, "90th_percentile": 735.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 406.81, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 589.23, "10th_percentile": 443.29, "90th_percentile": 735.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 361.13, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 361.13, "10th_percentile": 361.13, "90th_percentile": 361.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1080.29, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1080.29, "10th_percentile": 1080.29, "90th_percentile": 1080.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 895.1, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 895.1, "10th_percentile": 895.1, "90th_percentile": 895.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 694.47, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 530.3, "10th_percentile": 398.96, "90th_percentile": 661.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 366.12, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 530.3, "10th_percentile": 398.96, "90th_percentile": 661.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 694.47, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 694.47, "10th_percentile": 694.47, "90th_percentile": 694.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 694.47, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 694.47, "10th_percentile": 694.47, "90th_percentile": 694.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 189.57, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 527.22, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 244.08, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 472.71, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 157.84, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 650.89, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $813.61 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $813.61 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 650.89, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 650.89, "10th_percentile": 650.89, "90th_percentile": 650.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 528.85, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 528.85, "10th_percentile": 528.85, "90th_percentile": 528.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 406.81, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 406.81, "10th_percentile": 406.81, "90th_percentile": 406.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 260.36, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 260.36, "10th_percentile": 260.36, "90th_percentile": 260.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 691.57, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 691.57, "10th_percentile": 691.57, "90th_percentile": 691.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 667.16, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 667.16, "10th_percentile": 667.16, "90th_percentile": 667.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 474.33, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 474.33, "10th_percentile": 474.33, "90th_percentile": 474.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 287.2, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 287.2, "10th_percentile": 287.2, "90th_percentile": 287.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 325.44, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 325.44, "10th_percentile": 325.44, "90th_percentile": 325.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 325.44, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 325.44, "10th_percentile": 325.44, "90th_percentile": 325.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "3.5MM CANN SCR FULL THD 42MM", "code_information": [ { "code": "SUP-353233", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 157.84, "maximum": 1543.27, "setting": "outpatient", "gross_charge": 1543.27, "discounted_cash": 1080.29, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 416.68, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 318.18, "10th_percentile": 239.37, "90th_percentile": 396.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 219.67, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 318.18, "10th_percentile": 239.37, "90th_percentile": 396.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 416.68, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 416.68, "10th_percentile": 416.68, "90th_percentile": 416.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 771.64, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 771.64, "10th_percentile": 771.64, "90th_percentile": 771.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 771.64, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 589.23, "10th_percentile": 443.29, "90th_percentile": 735.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 406.81, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 589.23, "10th_percentile": 443.29, "90th_percentile": 735.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 361.13, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 361.13, "10th_percentile": 361.13, "90th_percentile": 361.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1080.29, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1080.29, "10th_percentile": 1080.29, "90th_percentile": 1080.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 895.1, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 895.1, "10th_percentile": 895.1, "90th_percentile": 895.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 694.47, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 530.3, "10th_percentile": 398.96, "90th_percentile": 661.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 366.12, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 530.3, "10th_percentile": 398.96, "90th_percentile": 661.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 694.47, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 694.47, "10th_percentile": 694.47, "90th_percentile": 694.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 694.47, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 694.47, "10th_percentile": 694.47, "90th_percentile": 694.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 189.57, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 527.22, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 244.08, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 472.71, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 157.84, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 650.89, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $813.61 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $813.61 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 650.89, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 650.89, "10th_percentile": 650.89, "90th_percentile": 650.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 528.85, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 528.85, "10th_percentile": 528.85, "90th_percentile": 528.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 406.81, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 406.81, "10th_percentile": 406.81, "90th_percentile": 406.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 260.36, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 260.36, "10th_percentile": 260.36, "90th_percentile": 260.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 691.57, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 691.57, "10th_percentile": 691.57, "90th_percentile": 691.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 667.16, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 667.16, "10th_percentile": 667.16, "90th_percentile": 667.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 474.33, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 474.33, "10th_percentile": 474.33, "90th_percentile": 474.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 287.2, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 287.2, "10th_percentile": 287.2, "90th_percentile": 287.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 325.44, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 325.44, "10th_percentile": 325.44, "90th_percentile": 325.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 325.44, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 325.44, "10th_percentile": 325.44, "90th_percentile": 325.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "3.5MM CANN SCR PARTIAL THD 18MM", "code_information": [ { "code": "SUP-353206", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 157.84, "maximum": 1543.27, "setting": "outpatient", "gross_charge": 1543.27, "discounted_cash": 1080.29, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 416.68, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 318.18, "10th_percentile": 239.37, "90th_percentile": 396.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 219.67, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 318.18, "10th_percentile": 239.37, "90th_percentile": 396.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 416.68, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 416.68, "10th_percentile": 416.68, "90th_percentile": 416.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 771.64, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 771.64, "10th_percentile": 771.64, "90th_percentile": 771.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 771.64, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 589.23, "10th_percentile": 443.29, "90th_percentile": 735.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 406.81, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 589.23, "10th_percentile": 443.29, "90th_percentile": 735.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 361.13, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 361.13, "10th_percentile": 361.13, "90th_percentile": 361.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1080.29, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1080.29, "10th_percentile": 1080.29, "90th_percentile": 1080.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 895.1, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 895.1, "10th_percentile": 895.1, "90th_percentile": 895.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 694.47, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 530.3, "10th_percentile": 398.96, "90th_percentile": 661.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 366.12, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 530.3, "10th_percentile": 398.96, "90th_percentile": 661.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 694.47, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 694.47, "10th_percentile": 694.47, "90th_percentile": 694.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 694.47, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 694.47, "10th_percentile": 694.47, "90th_percentile": 694.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 189.57, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 527.22, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 244.08, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 472.71, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 157.84, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 650.89, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $813.61 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $813.61 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 650.89, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 650.89, "10th_percentile": 650.89, "90th_percentile": 650.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 528.85, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 528.85, "10th_percentile": 528.85, "90th_percentile": 528.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 406.81, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 406.81, "10th_percentile": 406.81, "90th_percentile": 406.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 260.36, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 260.36, "10th_percentile": 260.36, "90th_percentile": 260.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 691.57, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 691.57, "10th_percentile": 691.57, "90th_percentile": 691.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 667.16, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 667.16, "10th_percentile": 667.16, "90th_percentile": 667.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 474.33, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 474.33, "10th_percentile": 474.33, "90th_percentile": 474.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 287.2, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 287.2, "10th_percentile": 287.2, "90th_percentile": 287.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 325.44, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 325.44, "10th_percentile": 325.44, "90th_percentile": 325.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 325.44, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 325.44, "10th_percentile": 325.44, "90th_percentile": 325.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "3.5MM CANN SCR PARTIAL THD 46MM", "code_information": [ { "code": "SUP-353237", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 157.84, "maximum": 1543.27, "setting": "outpatient", "gross_charge": 1543.27, "discounted_cash": 1080.29, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 416.68, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 318.18, "10th_percentile": 239.37, "90th_percentile": 396.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 219.67, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 318.18, "10th_percentile": 239.37, "90th_percentile": 396.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 416.68, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 416.68, "10th_percentile": 416.68, "90th_percentile": 416.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 771.64, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 771.64, "10th_percentile": 771.64, "90th_percentile": 771.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 771.64, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 589.23, "10th_percentile": 443.29, "90th_percentile": 735.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 406.81, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 589.23, "10th_percentile": 443.29, "90th_percentile": 735.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 361.13, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 361.13, "10th_percentile": 361.13, "90th_percentile": 361.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1080.29, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1080.29, "10th_percentile": 1080.29, "90th_percentile": 1080.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 895.1, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 895.1, "10th_percentile": 895.1, "90th_percentile": 895.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 694.47, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 530.3, "10th_percentile": 398.96, "90th_percentile": 661.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 366.12, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 530.3, "10th_percentile": 398.96, "90th_percentile": 661.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 694.47, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 694.47, "10th_percentile": 694.47, "90th_percentile": 694.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 694.47, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 694.47, "10th_percentile": 694.47, "90th_percentile": 694.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1178.44, "10th_percentile": 886.58, "90th_percentile": 1470.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 189.57, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 527.22, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 244.08, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 472.71, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 157.84, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 650.89, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $813.61 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $813.61 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 650.89, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 650.89, "10th_percentile": 650.89, "90th_percentile": 650.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 528.85, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 528.85, "10th_percentile": 528.85, "90th_percentile": 528.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 406.81, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 406.81, "10th_percentile": 406.81, "90th_percentile": 406.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 260.36, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 260.36, "10th_percentile": 260.36, "90th_percentile": 260.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 691.57, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 691.57, "10th_percentile": 691.57, "90th_percentile": 691.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 667.16, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 667.16, "10th_percentile": 667.16, "90th_percentile": 667.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 474.33, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 474.33, "10th_percentile": 474.33, "90th_percentile": 474.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 287.2, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 287.2, "10th_percentile": 287.2, "90th_percentile": 287.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 325.44, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 325.44, "10th_percentile": 325.44, "90th_percentile": 325.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 325.44, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 325.44, "10th_percentile": 325.44, "90th_percentile": 325.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 813.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 813.61, "10th_percentile": 813.61, "90th_percentile": 813.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "3.5MM CORT SCR SELF-TAP SMALL HEX 32MM", "code_information": [ { "code": "SUP-353341", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 24.22, "maximum": 124.82, "setting": "outpatient", "gross_charge": 124.82, "discounted_cash": 87.37, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 33.7, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 33.7, "10th_percentile": 33.7, "90th_percentile": 33.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 62.41, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 62.41, "10th_percentile": 62.41, "90th_percentile": 62.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 56.17, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 56.17, "10th_percentile": 56.17, "90th_percentile": 56.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 124.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 124.82, "10th_percentile": 124.82, "90th_percentile": 124.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 124.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 124.82, "10th_percentile": 124.82, "90th_percentile": 124.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 124.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 124.82, "10th_percentile": 124.82, "90th_percentile": 124.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 124.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 124.82, "10th_percentile": 124.82, "90th_percentile": 124.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 124.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 124.82, "10th_percentile": 124.82, "90th_percentile": 124.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 124.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 124.82, "10th_percentile": 124.82, "90th_percentile": 124.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 124.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 124.82, "10th_percentile": 124.82, "90th_percentile": 124.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 29.08, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 80.88, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 37.45, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 72.52, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 24.22, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 99.86, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 124.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $124.82 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 124.82, "10th_percentile": 124.82, "90th_percentile": 124.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $124.82 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 99.86, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 99.86, "10th_percentile": 99.86, "90th_percentile": 99.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 81.13, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 81.13, "10th_percentile": 81.13, "90th_percentile": 81.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 62.41, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 62.41, "10th_percentile": 62.41, "90th_percentile": 62.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 39.94, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 39.94, "10th_percentile": 39.94, "90th_percentile": 39.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 106.1, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 106.1, "10th_percentile": 106.1, "90th_percentile": 106.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 124.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 124.82, "10th_percentile": 124.82, "90th_percentile": 124.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 102.35, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 102.35, "10th_percentile": 102.35, "90th_percentile": 102.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 72.77, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 72.77, "10th_percentile": 72.77, "90th_percentile": 72.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 44.06, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 44.06, "10th_percentile": 44.06, "90th_percentile": 44.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 49.93, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 49.93, "10th_percentile": 49.93, "90th_percentile": 49.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 49.93, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 49.93, "10th_percentile": 49.93, "90th_percentile": 49.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 124.82, "10th_percentile": 124.82, "90th_percentile": 124.82, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 124.82, "10th_percentile": 124.82, "90th_percentile": 124.82, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 124.82, "10th_percentile": 124.82, "90th_percentile": 124.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 124.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 124.82, "10th_percentile": 124.82, "90th_percentile": 124.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "3.5MM T-PLT OBLQ 3 HL HEAD 5 HL SHFT 74MM", "code_information": [ { "code": "SUP-353396", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 143.49, "maximum": 1402.98, "setting": "outpatient", "gross_charge": 739.65, "discounted_cash": 517.75, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 199.71, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 289.25, "10th_percentile": 217.62, "90th_percentile": 360.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 378.8, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 289.25, "10th_percentile": 217.62, "90th_percentile": 360.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 378.8, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 378.8, "10th_percentile": 378.8, "90th_percentile": 378.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 701.49, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 701.49, "10th_percentile": 701.49, "90th_percentile": 701.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 369.83, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 535.66, "10th_percentile": 403.0, "90th_percentile": 668.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 701.49, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 535.66, "10th_percentile": 403.0, "90th_percentile": 668.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 328.3, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 328.3, "10th_percentile": 328.3, "90th_percentile": 328.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 982.09, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 982.09, "10th_percentile": 982.09, "90th_percentile": 982.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 813.73, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 813.73, "10th_percentile": 813.73, "90th_percentile": 813.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 631.34, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 482.09, "10th_percentile": 362.69, "90th_percentile": 601.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 332.84, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 482.09, "10th_percentile": 362.69, "90th_percentile": 601.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 631.34, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 631.34, "10th_percentile": 631.34, "90th_percentile": 631.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 631.34, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 631.34, "10th_percentile": 631.34, "90th_percentile": 631.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1402.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1071.32, "10th_percentile": 805.98, "90th_percentile": 1336.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 739.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1071.32, "10th_percentile": 805.98, "90th_percentile": 1336.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1402.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1402.98, "10th_percentile": 1402.98, "90th_percentile": 1402.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1402.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1402.98, "10th_percentile": 1402.98, "90th_percentile": 1402.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1402.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1071.32, "10th_percentile": 805.98, "90th_percentile": 1336.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 739.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1071.32, "10th_percentile": 805.98, "90th_percentile": 1336.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 739.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1071.32, "10th_percentile": 805.98, "90th_percentile": 1336.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1402.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1071.32, "10th_percentile": 805.98, "90th_percentile": 1336.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1402.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1071.32, "10th_percentile": 805.98, "90th_percentile": 1336.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 739.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1071.32, "10th_percentile": 805.98, "90th_percentile": 1336.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 739.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1071.32, "10th_percentile": 805.98, "90th_percentile": 1336.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1402.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1071.32, "10th_percentile": 805.98, "90th_percentile": 1336.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 739.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1071.32, "10th_percentile": 805.98, "90th_percentile": 1336.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1402.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1071.32, "10th_percentile": 805.98, "90th_percentile": 1336.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1402.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1071.32, "10th_percentile": 805.98, "90th_percentile": 1336.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 739.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1071.32, "10th_percentile": 805.98, "90th_percentile": 1336.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 172.34, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 479.29, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 221.9, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 429.74, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 143.49, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 591.72, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 739.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $739.65 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 739.65, "10th_percentile": 739.65, "90th_percentile": 739.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $739.65 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 591.72, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 591.72, "10th_percentile": 591.72, "90th_percentile": 591.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 480.77, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 480.77, "10th_percentile": 480.77, "90th_percentile": 480.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 369.83, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 369.83, "10th_percentile": 369.83, "90th_percentile": 369.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 236.69, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 236.69, "10th_percentile": 236.69, "90th_percentile": 236.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 628.7, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 628.7, "10th_percentile": 628.7, "90th_percentile": 628.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 739.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 739.65, "10th_percentile": 739.65, "90th_percentile": 739.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 606.51, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 606.51, "10th_percentile": 606.51, "90th_percentile": 606.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 431.22, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 431.22, "10th_percentile": 431.22, "90th_percentile": 431.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 261.1, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 261.1, "10th_percentile": 261.1, "90th_percentile": 261.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 295.86, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 295.86, "10th_percentile": 295.86, "90th_percentile": 295.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 295.86, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 295.86, "10th_percentile": 295.86, "90th_percentile": 295.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 739.65, "10th_percentile": 739.65, "90th_percentile": 739.65, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 739.65, "10th_percentile": 739.65, "90th_percentile": 739.65, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 739.65, "10th_percentile": 739.65, "90th_percentile": 739.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 739.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 739.65, "10th_percentile": 739.65, "90th_percentile": 739.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "30-34MM X10 CROSSLINK MULTI", "code_information": [ { "code": "SUP-115463", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 340.79, "maximum": 3332.07, "setting": "outpatient", "gross_charge": 3332.07, "discounted_cash": 2332.45, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 899.66, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 474.3, "10th_percentile": 447.19, "90th_percentile": 814.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 474.3, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 474.3, "10th_percentile": 447.19, "90th_percentile": 814.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 440.41, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 474.3, "10th_percentile": 447.19, "90th_percentile": 814.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 899.66, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 899.66, "10th_percentile": 899.66, "90th_percentile": 899.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1666.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1666.04, "10th_percentile": 1666.04, "90th_percentile": 1666.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1666.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1272.18, "10th_percentile": 957.1, "90th_percentile": 1587.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 878.33, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1272.18, "10th_percentile": 957.1, "90th_percentile": 1587.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1932.6, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1932.6, "10th_percentile": 1932.6, "90th_percentile": 1932.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 2332.45, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 2332.45, "10th_percentile": 2332.45, "90th_percentile": 2332.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1499.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1499.43, "10th_percentile": 1499.43, "90th_percentile": 1499.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 790.5, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1144.97, "10th_percentile": 861.39, "90th_percentile": 1428.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1499.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1144.97, "10th_percentile": 861.39, "90th_percentile": 1428.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 1499.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1499.43, "10th_percentile": 1499.43, "90th_percentile": 1499.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1631.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1756.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1631.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2481.61, "10th_percentile": 1801.24, "90th_percentile": 3161.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2481.61, "10th_percentile": 1801.24, "90th_percentile": 3161.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1756.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1631.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1756.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1631.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1631.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1756.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1756.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1631.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1756.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1631.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1631.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1756.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1656.25, "90th_percentile": 3016.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 409.3, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 1138.32, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 527.0, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 1020.62, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 340.79, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1756.66, "10th_percentile": 1756.66, "90th_percentile": 1756.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 1756.66, "10th_percentile": 1756.66, "90th_percentile": 1756.66, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 1756.66, "10th_percentile": 1756.66, "90th_percentile": 1756.66, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 1405.33, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 1756.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,756.66 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1756.66, "10th_percentile": 1756.66, "90th_percentile": 1756.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,756.66 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1756.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1756.66, "90th_percentile": 1756.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 1405.33, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 1405.33, "10th_percentile": 1405.33, "90th_percentile": 1405.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1141.83, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 1141.83, "10th_percentile": 1141.83, "90th_percentile": 1141.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 878.33, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 878.33, "10th_percentile": 878.33, "90th_percentile": 878.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 562.13, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 562.13, "10th_percentile": 562.13, "90th_percentile": 562.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 1493.16, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 1493.16, "10th_percentile": 1493.16, "90th_percentile": 1493.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1756.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1756.66, "10th_percentile": 1756.66, "90th_percentile": 1756.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 1440.46, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 1440.46, "10th_percentile": 1440.46, "90th_percentile": 1440.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 1024.13, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1024.13, "10th_percentile": 1024.13, "90th_percentile": 1024.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 620.1, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 620.1, "10th_percentile": 620.1, "90th_percentile": 620.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 702.66, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 702.66, "10th_percentile": 702.66, "90th_percentile": 702.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 702.66, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 702.66, "10th_percentile": 702.66, "90th_percentile": 702.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" } ] } ] }, { "description": "3D LONG SCREW 7.5MM X 55MM TI", "code_information": [ { "code": "SUP-71523", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 420.13, "maximum": 1556.03, "setting": "outpatient", "gross_charge": 1556.03, "discounted_cash": 1089.22, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 420.13, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 420.13, "10th_percentile": 420.13, "90th_percentile": 420.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1556.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1556.03, "10th_percentile": 1556.03, "90th_percentile": 1556.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1556.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1556.03, "10th_percentile": 1556.03, "90th_percentile": 1556.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1556.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1556.03, "10th_percentile": 1556.03, "90th_percentile": 1556.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1556.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1556.03, "10th_percentile": 1556.03, "90th_percentile": 1556.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1556.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1556.03, "10th_percentile": 1556.03, "90th_percentile": 1556.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1556.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1556.03, "10th_percentile": 1556.03, "90th_percentile": 1556.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1556.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1556.03, "10th_percentile": 1556.03, "90th_percentile": 1556.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1556.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1556.03, "10th_percentile": 1556.03, "90th_percentile": 1556.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "3D THREAD SCRW 5.5MMX45 TI", "code_information": [ { "code": "SUP-70555", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 356.04, "maximum": 3481.13, "setting": "outpatient", "gross_charge": 3481.13, "discounted_cash": 2436.79, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 939.91, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 495.52, "10th_percentile": 467.19, "90th_percentile": 851.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 495.52, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 495.52, "10th_percentile": 467.19, "90th_percentile": 851.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 460.11, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 495.52, "10th_percentile": 467.19, "90th_percentile": 851.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 939.91, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 939.91, "10th_percentile": 939.91, "90th_percentile": 939.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1740.57, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1740.57, "10th_percentile": 1740.57, "90th_percentile": 1740.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1740.57, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1329.1, "10th_percentile": 999.92, "90th_percentile": 1658.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 917.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1329.1, "10th_percentile": 999.92, "90th_percentile": 1658.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 814.58, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 814.58, "10th_percentile": 814.58, "90th_percentile": 814.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 2436.79, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 2436.79, "10th_percentile": 2436.79, "90th_percentile": 2436.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 2019.06, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 2019.06, "10th_percentile": 2019.06, "90th_percentile": 2019.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 825.86, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1196.18, "10th_percentile": 899.92, "90th_percentile": 1492.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1566.51, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1196.18, "10th_percentile": 899.92, "90th_percentile": 1492.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1566.51, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1566.51, "10th_percentile": 1566.51, "90th_percentile": 1566.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 1566.51, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1566.51, "10th_percentile": 1566.51, "90th_percentile": 1566.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1704.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1835.25, "10th_percentile": 1730.35, "90th_percentile": 3151.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1835.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1835.25, "10th_percentile": 1730.35, "90th_percentile": 3151.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 3481.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1835.25, "10th_percentile": 1730.35, "90th_percentile": 3151.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3481.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3481.13, "10th_percentile": 3481.13, "90th_percentile": 3481.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1704.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2592.63, "10th_percentile": 1881.82, "90th_percentile": 3303.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3481.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2592.63, "10th_percentile": 1881.82, "90th_percentile": 3303.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1704.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1730.35, "90th_percentile": 3151.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1835.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1730.35, "90th_percentile": 3151.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3481.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1730.35, "90th_percentile": 3151.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1704.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1730.35, "90th_percentile": 3151.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1835.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1730.35, "90th_percentile": 3151.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3481.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1730.35, "90th_percentile": 3151.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3481.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1730.35, "90th_percentile": 3151.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1835.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1730.35, "90th_percentile": 3151.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1704.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1730.35, "90th_percentile": 3151.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1704.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1730.35, "90th_percentile": 3151.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1835.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1730.35, "90th_percentile": 3151.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3481.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1730.35, "90th_percentile": 3151.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1704.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1730.35, "90th_percentile": 3151.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1835.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1730.35, "90th_percentile": 3151.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3481.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1730.35, "90th_percentile": 3151.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1704.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1730.35, "90th_percentile": 3151.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1835.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1730.35, "90th_percentile": 3151.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3481.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1730.35, "90th_percentile": 3151.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 427.61, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 1189.24, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 550.58, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 1066.28, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 356.04, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 1468.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 1835.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,835.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1835.25, "10th_percentile": 1835.25, "90th_percentile": 1835.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,835.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 1468.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 1468.2, "10th_percentile": 1468.2, "90th_percentile": 1468.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1192.91, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 1192.91, "10th_percentile": 1192.91, "90th_percentile": 1192.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 917.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 917.63, "10th_percentile": 917.63, "90th_percentile": 917.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 587.28, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 587.28, "10th_percentile": 587.28, "90th_percentile": 587.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 1559.96, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 1559.96, "10th_percentile": 1559.96, "90th_percentile": 1559.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1835.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1835.25, "90th_percentile": 1835.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 1504.91, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% 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 Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 1069.95, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1069.95, "10th_percentile": 1069.95, "90th_percentile": 1069.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 647.84, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 647.84, "10th_percentile": 647.84, "90th_percentile": 647.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 734.1, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 734.1, "10th_percentile": 734.1, "90th_percentile": 734.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 734.1, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 734.1, "10th_percentile": 734.1, "90th_percentile": 734.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 1835.25, "10th_percentile": 1835.25, "90th_percentile": 1835.25, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 1835.25, "10th_percentile": 1835.25, "90th_percentile": 1835.25, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1835.25, "10th_percentile": 1835.25, "90th_percentile": 1835.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1835.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1835.25, "90th_percentile": 1835.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "3D THREAD SCRW 7.5MMX45 TI", "code_information": [ { "code": "SUP-70556", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 356.04, "maximum": 1835.25, "setting": "outpatient", "gross_charge": 1835.25, "discounted_cash": 1284.67, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 495.52, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 477.81, "10th_percentile": 463.65, "90th_percentile": 491.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 460.11, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 477.81, "10th_percentile": 463.65, "90th_percentile": 491.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 917.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 917.63, "10th_percentile": 917.63, "90th_percentile": 917.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 825.86, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 825.86, "10th_percentile": 825.86, "90th_percentile": 825.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1704.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1769.68, "10th_percentile": 1717.23, "90th_percentile": 1822.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1835.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1769.68, "10th_percentile": 1717.23, "90th_percentile": 1822.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1704.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1704.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1769.68, "10th_percentile": 1717.23, "90th_percentile": 1822.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1835.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1769.68, "10th_percentile": 1717.23, "90th_percentile": 1822.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1835.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1835.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1769.68, "10th_percentile": 1717.23, "90th_percentile": 1822.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1704.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1769.68, "10th_percentile": 1717.23, "90th_percentile": 1822.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1835.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1769.68, "10th_percentile": 1717.23, "90th_percentile": 1822.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1704.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1769.68, "10th_percentile": 1717.23, "90th_percentile": 1822.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1835.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1769.68, "10th_percentile": 1717.23, "90th_percentile": 1822.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 427.61, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 1189.24, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 550.58, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 1066.28, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 356.04, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 1468.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 1835.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,835.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1835.25, "10th_percentile": 1835.25, "90th_percentile": 1835.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,835.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 1468.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 1468.2, "10th_percentile": 1468.2, "90th_percentile": 1468.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1192.91, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 1192.91, "10th_percentile": 1192.91, "90th_percentile": 1192.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 917.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 917.63, "10th_percentile": 917.63, "90th_percentile": 917.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 587.28, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 587.28, "10th_percentile": 587.28, "90th_percentile": 587.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 1559.96, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 1559.96, "10th_percentile": 1559.96, "90th_percentile": 1559.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1835.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1835.25, "90th_percentile": 1835.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 1504.91, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% 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 Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 1069.95, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1069.95, "10th_percentile": 1069.95, "90th_percentile": 1069.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 647.84, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 647.84, "10th_percentile": 647.84, "90th_percentile": 647.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 734.1, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 734.1, "10th_percentile": 734.1, "90th_percentile": 734.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 734.1, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 734.1, "10th_percentile": 734.1, "90th_percentile": 734.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 1835.25, "10th_percentile": 1835.25, "90th_percentile": 1835.25, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 1835.25, "10th_percentile": 1835.25, "90th_percentile": 1835.25, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1835.25, "10th_percentile": 1835.25, "90th_percentile": 1835.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1835.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1835.25, "10th_percentile": 1835.25, "90th_percentile": 1835.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "4.0 X 15 SELF-DRILL FIX SCREW", "code_information": [ { "code": "SUP-106687", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 194.93, "maximum": 833.02, "setting": "outpatient", "gross_charge": 833.02, "discounted_cash": 583.11, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 224.92, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 224.92, "10th_percentile": 224.92, "90th_percentile": 224.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 224.92, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 224.92, "10th_percentile": 224.92, "90th_percentile": 224.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 416.51, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 416.51, "10th_percentile": 416.51, "90th_percentile": 416.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 416.51, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 416.51, "10th_percentile": 416.51, "90th_percentile": 416.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 194.93, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 194.93, "10th_percentile": 194.93, "90th_percentile": 194.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 483.15, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 483.15, "10th_percentile": 483.15, "90th_percentile": 483.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 583.11, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 583.11, "10th_percentile": 583.11, "90th_percentile": 583.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 374.86, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 374.86, "10th_percentile": 374.86, "90th_percentile": 374.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 374.86, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 374.86, "10th_percentile": 374.86, "90th_percentile": 374.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 374.86, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 374.86, "10th_percentile": 374.86, "90th_percentile": 374.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 833.02, "10th_percentile": 833.02, "90th_percentile": 833.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 833.02, "10th_percentile": 833.02, "90th_percentile": 833.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 833.02, "10th_percentile": 833.02, "90th_percentile": 833.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 833.02, "10th_percentile": 833.02, "90th_percentile": 833.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 833.02, "10th_percentile": 833.02, "90th_percentile": 833.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 833.02, "10th_percentile": 833.02, "90th_percentile": 833.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 833.02, "10th_percentile": 833.02, "90th_percentile": 833.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 833.02, "10th_percentile": 833.02, "90th_percentile": 833.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 833.02, "10th_percentile": 833.02, "90th_percentile": 833.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "4.0MM CANC SCR SMALL HEX 32MM FULLY THD", "code_information": [ { "code": "SUP-353366", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 19.95, "maximum": 195.1, "setting": "outpatient", "gross_charge": 102.86, "discounted_cash": 72.0, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 27.77, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.23, "10th_percentile": 30.26, "90th_percentile": 50.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 52.68, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.23, "10th_percentile": 30.26, "90th_percentile": 50.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 52.68, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 52.68, "10th_percentile": 52.68, "90th_percentile": 52.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 97.55, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 97.55, "10th_percentile": 97.55, "90th_percentile": 97.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 51.43, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 74.49, "10th_percentile": 56.04, "90th_percentile": 92.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 97.55, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 74.49, "10th_percentile": 56.04, "90th_percentile": 92.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 45.65, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 45.65, "10th_percentile": 45.65, "90th_percentile": 45.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 136.57, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 136.57, "10th_percentile": 136.57, "90th_percentile": 136.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 113.16, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 113.16, "10th_percentile": 113.16, "90th_percentile": 113.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 87.8, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.05, "10th_percentile": 50.44, "90th_percentile": 83.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 46.29, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.05, "10th_percentile": 50.44, "90th_percentile": 83.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 87.8, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 87.8, "10th_percentile": 87.8, "90th_percentile": 87.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 87.8, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 87.8, "10th_percentile": 87.8, "90th_percentile": 87.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 102.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 148.98, "10th_percentile": 112.08, "90th_percentile": 185.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 195.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 148.98, "10th_percentile": 112.08, "90th_percentile": 185.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 195.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 195.1, "10th_percentile": 195.1, "90th_percentile": 195.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 195.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 195.1, "10th_percentile": 195.1, "90th_percentile": 195.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 195.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 148.98, "10th_percentile": 112.08, "90th_percentile": 185.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 148.98, "10th_percentile": 112.08, "90th_percentile": 185.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 195.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 148.98, "10th_percentile": 112.08, "90th_percentile": 185.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 148.98, "10th_percentile": 112.08, "90th_percentile": 185.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 195.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 148.98, "10th_percentile": 112.08, "90th_percentile": 185.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 148.98, "10th_percentile": 112.08, "90th_percentile": 185.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 148.98, "10th_percentile": 112.08, "90th_percentile": 185.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 195.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 148.98, "10th_percentile": 112.08, "90th_percentile": 185.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 148.98, "10th_percentile": 112.08, "90th_percentile": 185.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 195.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 148.98, "10th_percentile": 112.08, "90th_percentile": 185.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 195.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 148.98, "10th_percentile": 112.08, "90th_percentile": 185.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 148.98, "10th_percentile": 112.08, "90th_percentile": 185.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 23.97, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 66.65, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 30.86, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 59.76, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 19.95, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 82.29, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 102.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $102.86 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 102.86, "10th_percentile": 102.86, "90th_percentile": 102.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $102.86 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 82.29, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 82.29, "10th_percentile": 82.29, "90th_percentile": 82.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 66.86, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 66.86, "10th_percentile": 66.86, "90th_percentile": 66.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 51.43, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 51.43, "10th_percentile": 51.43, "90th_percentile": 51.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 32.92, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 32.92, "10th_percentile": 32.92, "90th_percentile": 32.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 87.43, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 87.43, "10th_percentile": 87.43, "90th_percentile": 87.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 102.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 102.86, "10th_percentile": 102.86, "90th_percentile": 102.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 84.35, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 84.35, "10th_percentile": 84.35, "90th_percentile": 84.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 59.97, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.97, "10th_percentile": 59.97, "90th_percentile": 59.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 36.31, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 36.31, "10th_percentile": 36.31, "90th_percentile": 36.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 41.14, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% 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 Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 41.14, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% 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 Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 102.86, "10th_percentile": 102.86, "90th_percentile": 102.86, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 102.86, "10th_percentile": 102.86, "90th_percentile": 102.86, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 102.86, "10th_percentile": 102.86, "90th_percentile": 102.86, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 102.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.86, "10th_percentile": 102.86, "90th_percentile": 102.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "4.0MM CANN SCR 1/3 THD 10MM", "code_information": [ { "code": "SUP-353201", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 167.71, "maximum": 1639.73, "setting": "outpatient", "gross_charge": 1639.73, "discounted_cash": 1147.81, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 442.73, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 338.06, "10th_percentile": 254.33, "90th_percentile": 421.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 233.4, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 338.06, "10th_percentile": 254.33, "90th_percentile": 421.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 442.73, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 442.73, "10th_percentile": 442.73, "90th_percentile": 442.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 819.87, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 819.87, "10th_percentile": 819.87, "90th_percentile": 819.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 432.23, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 626.05, "10th_percentile": 470.99, "90th_percentile": 781.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 819.87, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 626.05, "10th_percentile": 470.99, "90th_percentile": 781.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 383.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 383.7, "10th_percentile": 383.7, "90th_percentile": 383.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1147.81, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1147.81, "10th_percentile": 1147.81, "90th_percentile": 1147.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 951.04, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 951.04, "10th_percentile": 951.04, "90th_percentile": 951.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 389.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 563.44, "10th_percentile": 423.9, "90th_percentile": 702.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 737.88, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 563.44, "10th_percentile": 423.9, "90th_percentile": 702.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 737.88, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 737.88, "10th_percentile": 737.88, "90th_percentile": 737.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 737.88, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 737.88, "10th_percentile": 737.88, "90th_percentile": 737.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 864.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 864.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 864.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 864.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 864.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 864.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 864.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 201.42, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 560.17, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 259.34, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 502.25, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 167.71, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 691.57, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 864.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $864.46 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 864.46, "10th_percentile": 864.46, "90th_percentile": 864.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $864.46 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 691.57, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 691.57, "10th_percentile": 691.57, "90th_percentile": 691.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 561.9, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 561.9, "10th_percentile": 561.9, "90th_percentile": 561.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 432.23, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 432.23, "10th_percentile": 432.23, "90th_percentile": 432.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 276.63, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 276.63, "10th_percentile": 276.63, "90th_percentile": 276.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 734.79, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 734.79, "10th_percentile": 734.79, "90th_percentile": 734.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 864.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 864.46, "10th_percentile": 864.46, "90th_percentile": 864.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 708.86, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 708.86, "10th_percentile": 708.86, "90th_percentile": 708.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 503.98, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 503.98, "10th_percentile": 503.98, "90th_percentile": 503.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 305.15, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 305.15, "10th_percentile": 305.15, "90th_percentile": 305.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 345.78, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 345.78, "10th_percentile": 345.78, "90th_percentile": 345.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 345.78, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 345.78, "10th_percentile": 345.78, "90th_percentile": 345.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 864.46, "10th_percentile": 864.46, "90th_percentile": 864.46, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 864.46, "10th_percentile": 864.46, "90th_percentile": 864.46, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 864.46, "10th_percentile": 864.46, "90th_percentile": 864.46, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 864.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 864.46, "10th_percentile": 864.46, "90th_percentile": 864.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "4.0MM CANN SCR 1/3 THD 26MM", "code_information": [ { "code": "SUP-353216", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 167.71, "maximum": 1639.73, "setting": "outpatient", "gross_charge": 1639.73, "discounted_cash": 1147.81, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 442.73, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 338.06, "10th_percentile": 254.33, "90th_percentile": 421.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 233.4, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 338.06, "10th_percentile": 254.33, "90th_percentile": 421.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 442.73, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 442.73, "10th_percentile": 442.73, "90th_percentile": 442.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 819.87, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 819.87, "10th_percentile": 819.87, "90th_percentile": 819.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 432.23, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 626.05, "10th_percentile": 470.99, "90th_percentile": 781.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 819.87, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 626.05, "10th_percentile": 470.99, "90th_percentile": 781.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 383.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 383.7, "10th_percentile": 383.7, "90th_percentile": 383.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1147.81, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1147.81, "10th_percentile": 1147.81, "90th_percentile": 1147.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 951.04, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 951.04, "10th_percentile": 951.04, "90th_percentile": 951.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 737.88, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 563.44, "10th_percentile": 423.9, "90th_percentile": 702.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 389.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 563.44, "10th_percentile": 423.9, "90th_percentile": 702.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 737.88, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 737.88, "10th_percentile": 737.88, "90th_percentile": 737.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 737.88, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 737.88, "10th_percentile": 737.88, "90th_percentile": 737.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 864.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 864.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 864.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 864.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 864.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 864.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 864.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1252.1, "10th_percentile": 941.99, "90th_percentile": 1562.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 201.42, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 560.17, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 259.34, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 502.25, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 167.71, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 691.57, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 864.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $864.46 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 864.46, "10th_percentile": 864.46, "90th_percentile": 864.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $864.46 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 691.57, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 691.57, "10th_percentile": 691.57, "90th_percentile": 691.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 561.9, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 561.9, "10th_percentile": 561.9, "90th_percentile": 561.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 432.23, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 432.23, "10th_percentile": 432.23, "90th_percentile": 432.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 276.63, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 276.63, "10th_percentile": 276.63, "90th_percentile": 276.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 734.79, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 734.79, "10th_percentile": 734.79, "90th_percentile": 734.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 864.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 864.46, "10th_percentile": 864.46, "90th_percentile": 864.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 708.86, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 708.86, "10th_percentile": 708.86, "90th_percentile": 708.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 503.98, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 503.98, "10th_percentile": 503.98, "90th_percentile": 503.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 305.15, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 305.15, "10th_percentile": 305.15, "90th_percentile": 305.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 345.78, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 345.78, "10th_percentile": 345.78, "90th_percentile": 345.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 345.78, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 345.78, "10th_percentile": 345.78, "90th_percentile": 345.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 864.46, "10th_percentile": 864.46, "90th_percentile": 864.46, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 864.46, "10th_percentile": 864.46, "90th_percentile": 864.46, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 864.46, "10th_percentile": 864.46, "90th_percentile": 864.46, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 864.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 864.46, "10th_percentile": 864.46, "90th_percentile": 864.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "4.0MM CANN SCRW-LONG THRD 52MM", "code_information": [ { "code": "SUP-377137", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 112.1, "maximum": 1096.08, "setting": "outpatient", "gross_charge": 1096.08, "discounted_cash": 767.26, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 295.94, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 156.02, "10th_percentile": 143.72, "90th_percentile": 267.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 140.65, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 156.02, "10th_percentile": 143.72, "90th_percentile": 267.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 156.02, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 156.02, "10th_percentile": 143.72, "90th_percentile": 267.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 295.94, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 295.94, "10th_percentile": 295.94, "90th_percentile": 295.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 548.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 548.04, "10th_percentile": 548.04, "90th_percentile": 548.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 548.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 418.49, "10th_percentile": 314.84, "90th_percentile": 522.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 288.93, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 418.49, "10th_percentile": 314.84, "90th_percentile": 522.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 256.48, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 256.48, "10th_percentile": 256.48, "90th_percentile": 256.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 767.26, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 767.26, "10th_percentile": 767.26, "90th_percentile": 767.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 635.73, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 635.73, "10th_percentile": 635.73, "90th_percentile": 635.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 493.24, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 376.63, "10th_percentile": 283.35, "90th_percentile": 469.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 260.03, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 376.63, "10th_percentile": 283.35, "90th_percentile": 469.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 493.24, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 493.24, "10th_percentile": 493.24, "90th_percentile": 493.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 493.24, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 493.24, "10th_percentile": 493.24, "90th_percentile": 493.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 577.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 520.94, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1096.08, "10th_percentile": 1096.08, "90th_percentile": 1096.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 808.51, "10th_percentile": 578.45, "90th_percentile": 1038.57, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 520.94, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 808.51, "10th_percentile": 578.45, "90th_percentile": 1038.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 520.94, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 577.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 520.94, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 577.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 577.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 520.94, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 577.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 520.94, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 520.94, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 577.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 577.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 520.94, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 134.64, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 374.45, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 173.36, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 335.73, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 112.1, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 462.28, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 577.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $577.85 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 577.85, "10th_percentile": 577.85, "90th_percentile": 577.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $577.85 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 462.28, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 462.28, "10th_percentile": 462.28, "90th_percentile": 462.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 375.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 375.6, "10th_percentile": 375.6, "90th_percentile": 375.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 288.93, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 288.93, "10th_percentile": 288.93, "90th_percentile": 288.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 184.91, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 184.91, "10th_percentile": 184.91, "90th_percentile": 184.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 491.17, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 491.17, "10th_percentile": 491.17, "90th_percentile": 491.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 577.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 577.85, "10th_percentile": 577.85, "90th_percentile": 577.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 473.84, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 473.84, "10th_percentile": 473.84, "90th_percentile": 473.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 336.89, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 336.89, "10th_percentile": 336.89, "90th_percentile": 336.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 203.98, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 203.98, "10th_percentile": 203.98, "90th_percentile": 203.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 231.14, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 231.14, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 577.85, "10th_percentile": 577.85, "90th_percentile": 577.85, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 577.85, "10th_percentile": 577.85, "90th_percentile": 577.85, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 577.85, "10th_percentile": 577.85, "90th_percentile": 577.85, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 577.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 577.85, "90th_percentile": 577.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "4.0MM CANN SCRW-LONG THRD 64MM", "code_information": [ { "code": "SUP-377140", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 112.1, "maximum": 1096.08, "setting": "outpatient", "gross_charge": 1096.08, "discounted_cash": 767.26, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 295.94, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 156.02, "10th_percentile": 143.72, "90th_percentile": 267.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 140.65, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 156.02, "10th_percentile": 143.72, "90th_percentile": 267.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 156.02, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 156.02, "10th_percentile": 143.72, "90th_percentile": 267.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 295.94, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 295.94, "10th_percentile": 295.94, "90th_percentile": 295.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 548.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 548.04, "10th_percentile": 548.04, "90th_percentile": 548.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 548.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 418.49, "10th_percentile": 314.84, "90th_percentile": 522.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 288.93, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 418.49, "10th_percentile": 314.84, "90th_percentile": 522.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 256.48, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 256.48, "10th_percentile": 256.48, "90th_percentile": 256.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 767.26, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 767.26, "10th_percentile": 767.26, "90th_percentile": 767.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 635.73, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 635.73, "10th_percentile": 635.73, "90th_percentile": 635.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 493.24, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 376.63, "10th_percentile": 283.35, "90th_percentile": 469.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 260.03, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 376.63, "10th_percentile": 283.35, "90th_percentile": 469.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 493.24, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 493.24, "10th_percentile": 493.24, "90th_percentile": 493.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 493.24, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 493.24, "10th_percentile": 493.24, "90th_percentile": 493.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 577.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 520.94, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1096.08, "10th_percentile": 1096.08, "90th_percentile": 1096.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 808.51, "10th_percentile": 578.45, "90th_percentile": 1038.57, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 520.94, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 808.51, "10th_percentile": 578.45, "90th_percentile": 1038.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 520.94, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 577.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 520.94, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 577.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 577.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 520.94, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 577.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 520.94, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 520.94, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 577.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 577.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 520.94, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 532.32, "90th_percentile": 992.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 134.64, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 374.45, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 173.36, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 335.73, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 112.1, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 462.28, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 577.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $577.85 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 577.85, "10th_percentile": 577.85, "90th_percentile": 577.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $577.85 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 462.28, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 462.28, "10th_percentile": 462.28, "90th_percentile": 462.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 375.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 375.6, "10th_percentile": 375.6, "90th_percentile": 375.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 288.93, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 288.93, "10th_percentile": 288.93, "90th_percentile": 288.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 184.91, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 184.91, "10th_percentile": 184.91, "90th_percentile": 184.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 491.17, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 491.17, "10th_percentile": 491.17, "90th_percentile": 491.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 577.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 577.85, "10th_percentile": 577.85, "90th_percentile": 577.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 473.84, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 473.84, "10th_percentile": 473.84, "90th_percentile": 473.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 336.89, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 336.89, "10th_percentile": 336.89, "90th_percentile": 336.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 203.98, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 203.98, "10th_percentile": 203.98, "90th_percentile": 203.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 231.14, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 231.14, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 577.85, "10th_percentile": 577.85, "90th_percentile": 577.85, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 577.85, "10th_percentile": 577.85, "90th_percentile": 577.85, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 577.85, "10th_percentile": 577.85, "90th_percentile": 577.85, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 577.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 577.85, "10th_percentile": 577.85, "90th_percentile": 577.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "4.0MM TI CANC BONE SCRW FT 35MM", "code_information": [ { "code": "SUP-377171", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 9.15, "maximum": 133.81, "setting": "outpatient", "gross_charge": 133.81, "discounted_cash": 93.67, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 36.13, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 12.26, "90th_percentile": 32.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 19.05, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 12.26, "90th_percentile": 32.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 10.56, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 12.26, "90th_percentile": 32.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 10.56, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.35, "10th_percentile": 13.12, "90th_percentile": 33.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 36.13, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.35, "10th_percentile": 13.12, "90th_percentile": 33.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 66.91, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 66.91, "10th_percentile": 66.91, "90th_percentile": 66.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 66.91, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 51.09, "10th_percentile": 38.43, "90th_percentile": 63.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 35.27, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 51.09, "10th_percentile": 38.43, "90th_percentile": 63.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 31.31, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 20.23, "10th_percentile": 11.37, "90th_percentile": 29.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 9.15, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 20.23, "10th_percentile": 11.37, "90th_percentile": 29.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 93.67, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 93.67, "10th_percentile": 93.67, "90th_percentile": 93.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 77.61, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 77.61, "10th_percentile": 77.61, "90th_percentile": 77.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 31.74, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.98, "10th_percentile": 34.59, "90th_percentile": 57.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 60.21, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.98, "10th_percentile": 34.59, "90th_percentile": 57.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 60.21, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 60.21, "10th_percentile": 60.21, "90th_percentile": 60.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 60.21, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 60.21, "10th_percentile": 60.21, "90th_percentile": 60.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 133.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 102.18, "10th_percentile": 76.87, "90th_percentile": 127.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 70.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 102.18, "10th_percentile": 76.87, "90th_percentile": 127.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 133.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 133.81, "10th_percentile": 133.81, "90th_percentile": 133.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 133.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 133.81, "10th_percentile": 133.81, "90th_percentile": 133.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 133.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.18, "10th_percentile": 76.87, "90th_percentile": 127.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 70.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.18, "10th_percentile": 76.87, "90th_percentile": 127.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 70.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.18, "10th_percentile": 76.87, "90th_percentile": 127.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 133.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.18, "10th_percentile": 76.87, "90th_percentile": 127.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 70.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.18, "10th_percentile": 76.87, "90th_percentile": 127.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 133.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.18, "10th_percentile": 76.87, "90th_percentile": 127.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 70.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.18, "10th_percentile": 76.87, "90th_percentile": 127.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 133.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.18, "10th_percentile": 76.87, "90th_percentile": 127.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 70.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.18, "10th_percentile": 76.87, "90th_percentile": 127.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 133.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.18, "10th_percentile": 76.87, "90th_percentile": 127.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 70.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.18, "10th_percentile": 76.87, "90th_percentile": 127.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 133.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 102.18, "10th_percentile": 76.87, "90th_percentile": 127.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 16.44, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 45.71, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 21.16, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 40.98, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 13.68, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 56.43, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 70.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $70.54 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 70.54, "10th_percentile": 70.54, "90th_percentile": 70.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $70.54 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 56.43, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 56.43, "10th_percentile": 56.43, "90th_percentile": 56.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 45.85, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 45.85, "10th_percentile": 45.85, "90th_percentile": 45.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 35.27, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 35.27, "10th_percentile": 35.27, "90th_percentile": 35.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 22.57, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 22.57, "10th_percentile": 22.57, "90th_percentile": 22.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 59.96, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 59.96, "10th_percentile": 59.96, "90th_percentile": 59.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 70.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 70.54, "10th_percentile": 70.54, "90th_percentile": 70.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 57.84, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 57.84, "10th_percentile": 57.84, "90th_percentile": 57.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 41.12, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 41.12, "10th_percentile": 41.12, "90th_percentile": 41.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 24.9, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 24.9, "10th_percentile": 24.9, "90th_percentile": 24.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 28.22, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 28.22, "10th_percentile": 28.22, "90th_percentile": 28.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 28.22, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 28.22, "10th_percentile": 28.22, "90th_percentile": 28.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 70.54, "10th_percentile": 70.54, "90th_percentile": 70.54, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 70.54, "10th_percentile": 70.54, "90th_percentile": 70.54, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 70.54, "10th_percentile": 70.54, "90th_percentile": 70.54, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 70.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 70.54, "10th_percentile": 70.54, "90th_percentile": 70.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "4.5 X 15 SELF-TAP FIX SCREW", "code_information": [ { "code": "SUP-107669", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 85.2, "maximum": 833.02, "setting": "outpatient", "gross_charge": 407.79, "discounted_cash": 285.45, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 110.1, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.58, "10th_percentile": 111.8, "90th_percentile": 203.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 118.58, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.58, "10th_percentile": 111.8, "90th_percentile": 203.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 224.92, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.58, "10th_percentile": 111.8, "90th_percentile": 203.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 224.92, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 224.92, "10th_percentile": 224.92, "90th_percentile": 224.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 416.51, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 416.51, "10th_percentile": 416.51, "90th_percentile": 416.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 219.59, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 318.05, "10th_percentile": 239.28, "90th_percentile": 396.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 416.51, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 318.05, "10th_percentile": 239.28, "90th_percentile": 396.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 194.93, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 194.93, "10th_percentile": 194.93, "90th_percentile": 194.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 483.15, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 483.15, "10th_percentile": 483.15, "90th_percentile": 483.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 583.11, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 583.11, "10th_percentile": 583.11, "90th_percentile": 583.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 374.86, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 374.86, "10th_percentile": 374.86, "90th_percentile": 374.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 197.63, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 286.25, "10th_percentile": 215.35, "90th_percentile": 357.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 374.86, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 286.25, "10th_percentile": 215.35, "90th_percentile": 357.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 374.86, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 374.86, "10th_percentile": 374.86, "90th_percentile": 374.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 407.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 439.17, "10th_percentile": 414.07, "90th_percentile": 754.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 439.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 439.17, "10th_percentile": 414.07, "90th_percentile": 754.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 439.17, "10th_percentile": 414.07, "90th_percentile": 754.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 833.02, "10th_percentile": 833.02, "90th_percentile": 833.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 620.4, "10th_percentile": 450.31, "90th_percentile": 790.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 407.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 620.4, "10th_percentile": 450.31, "90th_percentile": 790.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 439.17, "10th_percentile": 414.07, "90th_percentile": 754.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 407.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 439.17, "10th_percentile": 414.07, "90th_percentile": 754.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 439.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 439.17, "10th_percentile": 414.07, "90th_percentile": 754.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 439.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 439.17, "10th_percentile": 414.07, "90th_percentile": 754.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 407.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 439.17, "10th_percentile": 414.07, "90th_percentile": 754.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 439.17, "10th_percentile": 414.07, "90th_percentile": 754.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 439.17, "10th_percentile": 414.07, "90th_percentile": 754.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 407.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 439.17, "10th_percentile": 414.07, "90th_percentile": 754.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 439.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 439.17, "10th_percentile": 414.07, "90th_percentile": 754.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 439.17, "10th_percentile": 414.07, "90th_percentile": 754.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 439.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 439.17, "10th_percentile": 414.07, "90th_percentile": 754.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 407.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 439.17, "10th_percentile": 414.07, "90th_percentile": 754.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 439.17, "10th_percentile": 414.07, "90th_percentile": 754.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 439.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 439.17, "10th_percentile": 414.07, "90th_percentile": 754.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 407.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 439.17, "10th_percentile": 414.07, "90th_percentile": 754.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 407.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 439.17, "10th_percentile": 414.07, "90th_percentile": 754.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 439.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 439.17, "10th_percentile": 414.07, "90th_percentile": 754.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 439.17, "10th_percentile": 414.07, "90th_percentile": 754.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 102.33, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 284.58, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 131.75, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 255.16, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 85.2, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 439.17, "10th_percentile": 439.17, "90th_percentile": 439.17, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 439.17, "10th_percentile": 439.17, "90th_percentile": 439.17, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 439.17, "10th_percentile": 439.17, "90th_percentile": 439.17, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 351.34, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 439.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $439.17 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 439.17, "10th_percentile": 439.17, "90th_percentile": 439.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $439.17 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 439.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 439.17, "10th_percentile": 439.17, "90th_percentile": 439.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 351.34, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 351.34, "10th_percentile": 351.34, "90th_percentile": 351.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 285.46, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 285.46, "10th_percentile": 285.46, "90th_percentile": 285.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 219.59, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 219.59, "10th_percentile": 219.59, "90th_percentile": 219.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 140.53, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 140.53, "10th_percentile": 140.53, "90th_percentile": 140.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 373.29, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 373.29, "10th_percentile": 373.29, "90th_percentile": 373.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 439.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 439.17, "10th_percentile": 439.17, "90th_percentile": 439.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 360.12, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 360.12, "10th_percentile": 360.12, "90th_percentile": 360.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 256.04, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 256.04, "10th_percentile": 256.04, "90th_percentile": 256.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 155.03, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 155.03, "10th_percentile": 155.03, "90th_percentile": 155.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 175.67, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 175.67, "10th_percentile": 175.67, "90th_percentile": 175.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 175.67, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 175.67, "10th_percentile": 175.67, "90th_percentile": 175.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" } ] } ] }, { "description": "4.5X15MM PK PAPYRUS COVERED STENT", "code_information": [ { "code": "SUP-350650", "type": "CDM" }, { "code": "C1874", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1618.73, "maximum": 32308.47, "setting": "outpatient", "gross_charge": 11589.75, "discounted_cash": 8112.82, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 11589.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18078.39, "10th_percentile": 11857.29, "90th_percentile": 29718.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 11589.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 23675.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18078.39, "10th_percentile": 11857.29, "90th_percentile": 29718.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 23675.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18078.39, "10th_percentile": 11857.29, "90th_percentile": 29718.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 23675.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18078.39, "10th_percentile": 11857.29, "90th_percentile": 29718.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 23675.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18078.39, "10th_percentile": 11857.29, "90th_percentile": 29718.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 32308.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18078.39, "10th_percentile": 11857.29, "90th_percentile": 29718.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 32308.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18078.39, "10th_percentile": 11857.29, "90th_percentile": 29718.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 32308.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18078.39, "10th_percentile": 11857.29, "90th_percentile": 29718.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 32308.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18078.39, "10th_percentile": 11857.29, "90th_percentile": 29718.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 32308.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18078.39, "10th_percentile": 11857.29, "90th_percentile": 29718.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 32308.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18078.39, "10th_percentile": 11857.29, "90th_percentile": 29718.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 11589.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 23675.22, "10th_percentile": 14006.84, "90th_percentile": 30581.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 23675.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 23675.22, "10th_percentile": 14006.84, "90th_percentile": 30581.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 32308.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 23675.22, "10th_percentile": 14006.84, "90th_percentile": 30581.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 32308.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 27991.85, "10th_percentile": 24538.55, "90th_percentile": 31445.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 23675.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 27991.85, "10th_percentile": 24538.55, "90th_percentile": 31445.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 32308.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 18078.39, "10th_percentile": 11857.29, "90th_percentile": 29718.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 23675.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 18078.39, "10th_percentile": 11857.29, "90th_percentile": 29718.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 12481.56, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 18078.39, "10th_percentile": 11857.29, "90th_percentile": 29718.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 11589.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 18078.39, "10th_percentile": 11857.29, "90th_percentile": 29718.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 14538.81, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12596.33, "10th_percentile": 11042.35, "90th_percentile": 14150.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 10653.85, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12596.33, "10th_percentile": 11042.35, "90th_percentile": 14150.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 10653.85, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12596.33, "10th_percentile": 11042.35, "90th_percentile": 14150.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 14538.81, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12596.33, "10th_percentile": 11042.35, "90th_percentile": 14150.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 14538.81, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10653.85, "10th_percentile": 6624.13, "90th_percentile": 13761.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 5616.7, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10653.85, "10th_percentile": 6624.13, "90th_percentile": 13761.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 10653.85, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10653.85, "10th_percentile": 6624.13, "90th_percentile": 13761.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 8723.29, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6392.31, "10th_percentile": 2772.68, "90th_percentile": 8257.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 6392.31, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6392.31, "10th_percentile": 2772.68, "90th_percentile": 8257.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1867.77, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6392.31, "10th_percentile": 2772.68, "90th_percentile": 8257.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 6392.31, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3370.02, "10th_percentile": 2372.35, "90th_percentile": 7790.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 8723.29, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3370.02, "10th_percentile": 2372.35, "90th_percentile": 7790.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3370.02, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3370.02, "10th_percentile": 2372.35, "90th_percentile": 7790.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3129.23, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3370.02, "10th_percentile": 2372.35, "90th_percentile": 7790.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1867.77, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3370.02, "10th_percentile": 2372.35, "90th_percentile": 7790.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 16154.24, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 13995.92, "10th_percentile": 12269.27, "90th_percentile": 15722.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 11837.61, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 13995.92, "10th_percentile": 12269.27, "90th_percentile": 15722.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 16154.24, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 11837.61, "10th_percentile": 7360.15, "90th_percentile": 15290.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 6240.78, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 11837.61, "10th_percentile": 7360.15, "90th_percentile": 15290.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 11837.61, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 11837.61, "10th_percentile": 7360.15, "90th_percentile": 15290.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1618.73, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 5540.0, "10th_percentile": 2402.98, "90th_percentile": 7156.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 5540.0, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 5540.0, "10th_percentile": 2402.98, "90th_percentile": 7156.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 7560.18, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 5540.0, "10th_percentile": 2402.98, "90th_percentile": 7156.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 16572.65, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 19594.29, "10th_percentile": 17176.98, "90th_percentile": 22011.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 22615.93, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 19594.29, "10th_percentile": 17176.98, "90th_percentile": 22011.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 13731.63, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 16235.27, "10th_percentile": 14232.36, "90th_percentile": 18238.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 18738.91, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 16235.27, "10th_percentile": 14232.36, "90th_percentile": 18238.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 12481.56, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $12,481.56 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 12481.56, "10th_percentile": 12481.56, "90th_percentile": 12481.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $12,481.56 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 7276.75, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7276.75, "10th_percentile": 7276.75, "90th_percentile": 7276.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 12481.56, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 12481.56, "10th_percentile": 12481.56, "90th_percentile": 12481.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 9985.25, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 9985.25, "10th_percentile": 9985.25, "90th_percentile": 9985.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 8113.01, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 8113.01, "10th_percentile": 8113.01, "90th_percentile": 8113.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 4405.99, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 4405.99, "10th_percentile": 4405.99, "90th_percentile": 4405.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 6240.78, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 6240.78, "10th_percentile": 6240.78, "90th_percentile": 6240.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 3744.47, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 3744.47, "10th_percentile": 3744.47, "90th_percentile": 3744.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 9985.25, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 9985.25, "10th_percentile": 9985.25, "90th_percentile": 9985.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 10609.33, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 10609.33, "10th_percentile": 10609.33, "90th_percentile": 10609.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 2421.42, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 2421.42, "10th_percentile": 2421.42, "90th_percentile": 2421.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 10234.88, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 10234.88, "10th_percentile": 10234.88, "90th_percentile": 10234.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 3994.1, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1150.38, "10th_percentile": 1150.38, "90th_percentile": 1150.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 8088.05, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1358.78, "10th_percentile": 1358.78, "90th_percentile": 1358.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 7251.79, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2088.66, "10th_percentile": 2088.66, "90th_percentile": 2088.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 2908.2, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1587.07, "10th_percentile": 1587.07, "90th_percentile": 1587.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 4992.62, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 4992.62, "10th_percentile": 4992.62, "90th_percentile": 4992.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 4992.62, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 4992.62, "10th_percentile": 4992.62, "90th_percentile": 4992.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 12481.56, "10th_percentile": 12481.56, "90th_percentile": 12481.56, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 8774.98, "10th_percentile": 8774.98, "90th_percentile": 8774.98, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 12481.56, "10th_percentile": 12481.56, "90th_percentile": 12481.56, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 12481.56, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12481.56, "10th_percentile": 12481.56, "90th_percentile": 12481.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "45-58MM X10 CROSSLINK MULTI", "code_information": [ { "code": "SUP-800354", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 779.7, "maximum": 3332.07, "setting": "outpatient", "gross_charge": 3332.07, "discounted_cash": 2332.45, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 899.66, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 899.66, "10th_percentile": 899.66, "90th_percentile": 899.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 899.66, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 899.66, "10th_percentile": 899.66, "90th_percentile": 899.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1666.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1666.04, "10th_percentile": 1666.04, "90th_percentile": 1666.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1666.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1666.04, "10th_percentile": 1666.04, "90th_percentile": 1666.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 2332.45, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 2332.45, "10th_percentile": 2332.45, "90th_percentile": 2332.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1932.6, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1932.6, "10th_percentile": 1932.6, "90th_percentile": 1932.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1499.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1499.43, "10th_percentile": 1499.43, "90th_percentile": 1499.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1499.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1499.43, "10th_percentile": 1499.43, "90th_percentile": 1499.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 1499.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1499.43, "10th_percentile": 1499.43, "90th_percentile": 1499.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "5.0MM X 24MM TI LOCKING SCREW SELF-TAPPNG W/T25 STARDRIVE RE", "code_information": [ { "code": "SUP-390580", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 114.43, "maximum": 1118.87, "setting": "outpatient", "gross_charge": 589.87, "discounted_cash": 412.91, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 159.26, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 230.67, "10th_percentile": 173.54, "90th_percentile": 287.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 302.09, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 230.67, "10th_percentile": 173.54, "90th_percentile": 287.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 302.09, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 302.09, "10th_percentile": 302.09, "90th_percentile": 302.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 559.44, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 559.44, "10th_percentile": 559.44, "90th_percentile": 559.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 294.94, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 427.19, "10th_percentile": 321.39, "90th_percentile": 532.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 559.44, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 427.19, "10th_percentile": 321.39, "90th_percentile": 532.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 261.82, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 261.82, "10th_percentile": 261.82, "90th_percentile": 261.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 783.21, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 783.21, "10th_percentile": 783.21, "90th_percentile": 783.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 648.94, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 648.94, "10th_percentile": 648.94, "90th_percentile": 648.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 503.49, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 384.47, "10th_percentile": 289.25, "90th_percentile": 479.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 265.44, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 384.47, "10th_percentile": 289.25, "90th_percentile": 479.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 503.49, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 503.49, "10th_percentile": 503.49, "90th_percentile": 503.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 503.49, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 503.49, "10th_percentile": 503.49, "90th_percentile": 503.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1118.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 854.37, "10th_percentile": 642.77, "90th_percentile": 1065.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 589.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 854.37, "10th_percentile": 642.77, "90th_percentile": 1065.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1118.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1118.87, "10th_percentile": 1118.87, "90th_percentile": 1118.87, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1118.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1118.87, "10th_percentile": 1118.87, "90th_percentile": 1118.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 589.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 854.37, "10th_percentile": 642.77, "90th_percentile": 1065.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1118.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 854.37, "10th_percentile": 642.77, "90th_percentile": 1065.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 589.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 854.37, "10th_percentile": 642.77, "90th_percentile": 1065.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1118.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 854.37, "10th_percentile": 642.77, "90th_percentile": 1065.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 589.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 854.37, "10th_percentile": 642.77, "90th_percentile": 1065.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1118.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 854.37, "10th_percentile": 642.77, "90th_percentile": 1065.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1118.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 854.37, "10th_percentile": 642.77, "90th_percentile": 1065.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 589.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 854.37, "10th_percentile": 642.77, "90th_percentile": 1065.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 589.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 854.37, "10th_percentile": 642.77, "90th_percentile": 1065.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1118.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 854.37, "10th_percentile": 642.77, "90th_percentile": 1065.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 589.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 854.37, "10th_percentile": 642.77, "90th_percentile": 1065.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1118.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 854.37, "10th_percentile": 642.77, "90th_percentile": 1065.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 137.44, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 382.24, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 176.96, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 342.71, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 114.43, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 471.9, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 589.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $589.87 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 589.87, "10th_percentile": 589.87, "90th_percentile": 589.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $589.87 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 471.9, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 471.9, "10th_percentile": 471.9, "90th_percentile": 471.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 383.42, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 383.42, "10th_percentile": 383.42, "90th_percentile": 383.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 294.94, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 294.94, "10th_percentile": 294.94, "90th_percentile": 294.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 188.76, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 188.76, "10th_percentile": 188.76, "90th_percentile": 188.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 501.39, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 501.39, "10th_percentile": 501.39, "90th_percentile": 501.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 589.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 589.87, "10th_percentile": 589.87, "90th_percentile": 589.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 483.69, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 483.69, "10th_percentile": 483.69, "90th_percentile": 483.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 343.89, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 343.89, "10th_percentile": 343.89, "90th_percentile": 343.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 208.22, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 208.22, "10th_percentile": 208.22, "90th_percentile": 208.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 235.95, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 235.95, "10th_percentile": 235.95, "90th_percentile": 235.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 235.95, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 235.95, "10th_percentile": 235.95, "90th_percentile": 235.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 589.87, "10th_percentile": 589.87, "90th_percentile": 589.87, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 589.87, "10th_percentile": 589.87, "90th_percentile": 589.87, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 589.87, "10th_percentile": 589.87, "90th_percentile": 589.87, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 589.87, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 589.87, "10th_percentile": 589.87, "90th_percentile": 589.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "5.5/6.35 CLS LAT CON 20MMTI", "code_information": [ { "code": "SUP-115168", "type": "CDM" }, { "code": "C1889", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 779.7, "maximum": 3332.07, "setting": "outpatient", "gross_charge": 3332.07, "discounted_cash": 2332.45, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 2332.45, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 2332.45, "10th_percentile": 2332.45, "90th_percentile": 2332.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1932.6, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1932.6, "10th_percentile": 1932.6, "90th_percentile": 1932.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1666.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1666.04, "10th_percentile": 1666.04, "90th_percentile": 1666.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1666.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1666.04, "10th_percentile": 1666.04, "90th_percentile": 1666.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 899.66, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 899.66, "10th_percentile": 899.66, "90th_percentile": 899.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 899.66, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 899.66, "10th_percentile": 899.66, "90th_percentile": 899.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 1499.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1499.43, "10th_percentile": 1499.43, "90th_percentile": 1499.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1499.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1499.43, "10th_percentile": 1499.43, "90th_percentile": 1499.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1499.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1499.43, "10th_percentile": 1499.43, "90th_percentile": 1499.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "5.5MM X 500MM OFFSET SRT COCR RELINE ROD", "code_information": [ { "code": "SUP-165763", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 224.21, "maximum": 3538.79, "setting": "outpatient", "gross_charge": 3538.79, "discounted_cash": 2477.15, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 955.47, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 451.96, "10th_percentile": 296.44, "90th_percentile": 846.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 591.88, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 451.96, "10th_percentile": 296.44, "90th_percentile": 846.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 312.04, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 451.96, "10th_percentile": 296.44, "90th_percentile": 846.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 289.75, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 451.96, "10th_percentile": 296.44, "90th_percentile": 846.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 591.88, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 773.67, "10th_percentile": 628.24, "90th_percentile": 919.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 955.47, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 773.67, "10th_percentile": 628.24, "90th_percentile": 919.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1432.74, "10th_percentile": 1163.41, "90th_percentile": 1702.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1769.4, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1432.74, "10th_percentile": 1163.41, "90th_percentile": 1702.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1096.08, "10th_percentile": 681.5, "90th_percentile": 1634.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1769.4, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1096.08, "10th_percentile": 681.5, "90th_percentile": 1634.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 577.85, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1096.08, "10th_percentile": 681.5, "90th_percentile": 1634.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 512.96, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 828.08, "10th_percentile": 575.98, "90th_percentile": 828.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 828.08, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 828.08, "10th_percentile": 575.98, "90th_percentile": 828.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 828.08, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 828.08, "10th_percentile": 575.98, "90th_percentile": 828.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1271.45, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1661.97, "10th_percentile": 1349.56, "90th_percentile": 1974.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 2052.5, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1661.97, "10th_percentile": 1349.56, "90th_percentile": 1974.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1534.51, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 2005.83, "10th_percentile": 1628.77, "90th_percentile": 2382.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 2477.15, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 2005.83, "10th_percentile": 1628.77, "90th_percentile": 2382.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC SEIU HEALTHLINK", "standard_charge_dollar": 1946.33, "standard_charge_percentage": 55.0, "standard_charge_algorithm": "All Services; 55% Billed", "median_amount": 1946.33, "10th_percentile": 1946.33, "90th_percentile": 1946.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 55% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 986.47, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1289.47, "10th_percentile": 1047.07, "90th_percentile": 1531.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1592.46, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1289.47, "10th_percentile": 1047.07, "90th_percentile": 1531.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 986.47, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 986.47, "10th_percentile": 613.35, "90th_percentile": 1471.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1592.46, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 986.47, "10th_percentile": 613.35, "90th_percentile": 1471.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 520.07, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 986.47, "10th_percentile": 613.35, "90th_percentile": 1471.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 986.47, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1289.47, "10th_percentile": 1047.07, "90th_percentile": 1531.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 1592.46, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1289.47, "10th_percentile": 1047.07, "90th_percentile": 1531.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1155.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1073.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2192.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 3538.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3538.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2865.47, "10th_percentile": 2326.81, "90th_percentile": 3404.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2192.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2865.47, "10th_percentile": 2326.81, "90th_percentile": 3404.13, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3538.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2192.15, "10th_percentile": 1296.93, "90th_percentile": 3269.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2192.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2192.15, "10th_percentile": 1296.93, "90th_percentile": 3269.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1073.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2192.15, "10th_percentile": 1296.93, "90th_percentile": 3269.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1155.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2192.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3538.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1073.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1155.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1073.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2192.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3538.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1073.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3538.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2192.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1155.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1073.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1155.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3538.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2192.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1073.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2192.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1155.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3538.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1073.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1155.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2192.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3538.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1673.93, "10th_percentile": 1097.9, "90th_percentile": 3134.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 269.28, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 748.89, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 346.71, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 671.46, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 224.21, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1155.7, "10th_percentile": 1155.7, "90th_percentile": 1155.7, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 1155.7, "10th_percentile": 1155.7, "90th_percentile": 1155.7, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 1155.7, "10th_percentile": 1155.7, "90th_percentile": 1155.7, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 924.56, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 1155.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,155.70 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1155.7, "10th_percentile": 1155.7, "90th_percentile": 1155.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,155.70 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1155.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1155.7, "10th_percentile": 1155.7, "90th_percentile": 1155.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 924.56, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 924.56, "10th_percentile": 924.56, "90th_percentile": 924.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 751.21, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 751.21, "10th_percentile": 751.21, "90th_percentile": 751.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 577.85, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 577.85, "10th_percentile": 577.85, "90th_percentile": 577.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 369.82, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 369.82, "10th_percentile": 369.82, "90th_percentile": 369.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 982.35, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 982.35, "10th_percentile": 982.35, "90th_percentile": 982.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1155.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1155.7, "10th_percentile": 1155.7, "90th_percentile": 1155.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 947.67, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 947.67, "10th_percentile": 947.67, "90th_percentile": 947.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 673.77, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 673.77, "10th_percentile": 673.77, "90th_percentile": 673.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 407.96, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 407.96, "10th_percentile": 407.96, "90th_percentile": 407.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 462.28, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 462.28, "10th_percentile": 462.28, "90th_percentile": 462.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 462.28, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 462.28, "10th_percentile": 462.28, "90th_percentile": 462.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" } ] } ] }, { "description": "5.5MM X 50MM POLY RELINE SPINAL BONE SCREW", "code_information": [ { "code": "SUP-311408", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 344.73, "maximum": 6122.22, "setting": "outpatient", "gross_charge": 6122.22, "discounted_cash": 4285.55, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1653.0, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 717.69, "10th_percentile": 497.46, "90th_percentile": 1536.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1361.33, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 717.69, "10th_percentile": 497.46, "90th_percentile": 1536.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 717.69, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 717.69, "10th_percentile": 497.46, "90th_percentile": 1536.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 647.0, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 717.69, "10th_percentile": 497.46, "90th_percentile": 1536.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 397.77, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 717.69, "10th_percentile": 497.46, "90th_percentile": 1536.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 397.77, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1361.33, "10th_percentile": 590.48, "90th_percentile": 1594.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1653.0, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1361.33, "10th_percentile": 590.48, "90th_percentile": 1594.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1361.33, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1361.33, "10th_percentile": 590.48, "90th_percentile": 1594.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2520.98, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2791.05, "10th_percentile": 2574.99, "90th_percentile": 3007.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3061.11, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2791.05, "10th_percentile": 2574.99, "90th_percentile": 3007.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2520.98, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2520.98, "10th_percentile": 1567.44, "90th_percentile": 2953.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3061.11, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2520.98, "10th_percentile": 1567.44, "90th_percentile": 2953.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1329.06, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2520.98, "10th_percentile": 1567.44, "90th_percentile": 2953.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1179.82, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1306.21, "10th_percentile": 595.26, "90th_percentile": 1432.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 344.73, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1306.21, "10th_percentile": 595.26, "90th_percentile": 1432.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1432.6, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1306.21, "10th_percentile": 595.26, "90th_percentile": 1432.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1432.6, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1306.21, "10th_percentile": 595.26, "90th_percentile": 1432.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 3550.89, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 3237.61, "10th_percentile": 2986.99, "90th_percentile": 3488.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 2924.33, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 3237.61, "10th_percentile": 2986.99, "90th_percentile": 3488.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 3529.37, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 3907.46, "10th_percentile": 3604.99, "90th_percentile": 4209.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 4285.55, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 3907.46, "10th_percentile": 3604.99, "90th_percentile": 4209.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC SEIU HEALTHLINK", "standard_charge_dollar": 3367.22, "standard_charge_percentage": 55.0, "standard_charge_algorithm": "All Services; 55% Billed", "median_amount": 3367.22, "10th_percentile": 3367.22, "90th_percentile": 3367.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 55% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2268.88, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2511.94, "10th_percentile": 2317.49, "90th_percentile": 2706.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2755.0, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2511.94, "10th_percentile": 2317.49, "90th_percentile": 2706.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1196.15, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2268.88, "10th_percentile": 1410.7, "90th_percentile": 2657.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2268.88, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2268.88, "10th_percentile": 1410.7, "90th_percentile": 2657.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2755.0, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2268.88, "10th_percentile": 1410.7, "90th_percentile": 2657.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 2268.88, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2511.94, "10th_percentile": 2317.49, "90th_percentile": 2706.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 2755.0, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2511.94, "10th_percentile": 2317.49, "90th_percentile": 2706.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 6122.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 5041.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2658.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2396.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6122.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5582.09, "10th_percentile": 5149.98, "90th_percentile": 6014.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5041.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5582.09, "10th_percentile": 5149.98, "90th_percentile": 6014.19, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5041.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5041.95, "10th_percentile": 2925.44, "90th_percentile": 5906.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6122.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5041.95, "10th_percentile": 2925.44, "90th_percentile": 5906.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2396.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5041.95, "10th_percentile": 2925.44, "90th_percentile": 5906.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5041.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2396.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2658.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6122.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5041.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6122.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2658.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2396.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2396.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2658.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5041.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6122.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5041.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2396.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2658.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6122.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2396.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2658.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6122.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5041.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2658.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5041.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6122.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2396.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3850.03, "10th_percentile": 2474.85, "90th_percentile": 5798.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 619.34, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 1722.46, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 797.43, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 1544.36, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 515.67, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2658.11, "10th_percentile": 2658.11, "90th_percentile": 2658.11, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 2658.11, "10th_percentile": 2658.11, "90th_percentile": 2658.11, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 2658.11, "10th_percentile": 2658.11, "90th_percentile": 2658.11, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 2126.49, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 2658.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2,658.11 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 2658.11, "10th_percentile": 2658.11, "90th_percentile": 2658.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2,658.11 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2658.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2658.11, "10th_percentile": 2658.11, "90th_percentile": 2658.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 2126.49, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 2126.49, "10th_percentile": 2126.49, "90th_percentile": 2126.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1727.77, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 1727.77, "10th_percentile": 1727.77, "90th_percentile": 1727.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 1329.06, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1329.06, "10th_percentile": 1329.06, "90th_percentile": 1329.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 850.6, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 850.6, "10th_percentile": 850.6, "90th_percentile": 850.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 2259.39, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 2259.39, "10th_percentile": 2259.39, "90th_percentile": 2259.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2658.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2658.11, "10th_percentile": 2658.11, "90th_percentile": 2658.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 2179.65, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 2179.65, "10th_percentile": 2179.65, "90th_percentile": 2179.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 1549.68, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1549.68, "10th_percentile": 1549.68, "90th_percentile": 1549.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 938.31, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 938.31, "10th_percentile": 938.31, "90th_percentile": 938.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 1063.24, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 1063.24, "10th_percentile": 1063.24, "90th_percentile": 1063.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 1063.24, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 1063.24, "10th_percentile": 1063.24, "90th_percentile": 1063.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" } ] } ] }, { "description": "58-80MM X10 CROSSLINK MULTI", "code_information": [ { "code": "SUP-800536", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 779.7, "maximum": 3332.07, "setting": "outpatient", "gross_charge": 3332.07, "discounted_cash": 2332.45, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 899.66, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 899.66, "10th_percentile": 899.66, "90th_percentile": 899.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 899.66, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 899.66, "10th_percentile": 899.66, "90th_percentile": 899.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1666.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1666.04, "10th_percentile": 1666.04, "90th_percentile": 1666.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1666.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1666.04, "10th_percentile": 1666.04, "90th_percentile": 1666.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 2332.45, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 2332.45, "10th_percentile": 2332.45, "90th_percentile": 2332.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1932.6, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1932.6, "10th_percentile": 1932.6, "90th_percentile": 1932.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1499.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1499.43, "10th_percentile": 1499.43, "90th_percentile": 1499.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1499.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1499.43, "10th_percentile": 1499.43, "90th_percentile": 1499.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 1499.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1499.43, "10th_percentile": 1499.43, "90th_percentile": 1499.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "5Fr Angled Pigtail 145 DxTerity w/Side Holes Diag Catheter", "code_information": [ { "code": "SUP-356649", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 13.45, "maximum": 69.34, "setting": "outpatient", "gross_charge": 64.39, "discounted_cash": 45.07, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 64.39, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 66.87, "10th_percentile": 64.89, "90th_percentile": 68.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 69.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 66.87, "10th_percentile": 64.89, "90th_percentile": 68.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 64.39, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 66.87, "10th_percentile": 64.89, "90th_percentile": 68.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 69.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 66.87, "10th_percentile": 64.89, "90th_percentile": 68.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 64.39, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 66.87, "10th_percentile": 64.89, "90th_percentile": 68.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 69.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 66.87, "10th_percentile": 64.89, "90th_percentile": 68.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 64.39, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 66.87, "10th_percentile": 64.89, "90th_percentile": 68.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 69.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 66.87, "10th_percentile": 64.89, "90th_percentile": 68.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 64.39, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 66.87, "10th_percentile": 64.89, "90th_percentile": 68.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 69.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 66.87, "10th_percentile": 64.89, "90th_percentile": 68.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 64.39, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 66.87, "10th_percentile": 64.89, "90th_percentile": 68.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 69.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 66.87, "10th_percentile": 64.89, "90th_percentile": 68.84, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 64.39, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 64.39, "10th_percentile": 64.39, "90th_percentile": 64.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 64.39, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 66.87, "10th_percentile": 64.89, "90th_percentile": 68.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 69.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 66.87, "10th_percentile": 64.89, "90th_percentile": 68.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 31.2, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 31.2, "10th_percentile": 31.2, "90th_percentile": 31.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 17.39, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.05, "10th_percentile": 17.52, "90th_percentile": 18.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 18.72, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.05, "10th_percentile": 17.52, "90th_percentile": 18.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 34.67, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 34.67, "10th_percentile": 34.67, "90th_percentile": 34.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 27.74, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 27.74, "10th_percentile": 27.74, "90th_percentile": 27.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 27.74, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 27.74, "10th_percentile": 27.74, "90th_percentile": 27.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 24.48, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 24.48, "10th_percentile": 24.48, "90th_percentile": 24.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 56.86, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 56.86, "10th_percentile": 56.86, "90th_percentile": 56.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 20.8, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 20.8, "10th_percentile": 20.8, "90th_percentile": 20.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 34.67, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 34.67, "10th_percentile": 34.67, "90th_percentile": 34.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 40.43, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.43, "10th_percentile": 40.43, "90th_percentile": 40.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 22.19, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 22.19, "10th_percentile": 22.19, "90th_percentile": 22.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 44.93, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.93, "10th_percentile": 44.93, "90th_percentile": 44.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 40.29, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.29, "10th_percentile": 40.29, "90th_percentile": 40.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 13.45, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 13.45, "10th_percentile": 13.45, "90th_percentile": 13.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 69.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 69.34, "10th_percentile": 69.34, "90th_percentile": 69.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 58.94, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 58.94, "10th_percentile": 58.94, "90th_percentile": 58.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 45.07, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 45.07, "10th_percentile": 45.07, "90th_percentile": 45.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 55.47, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 55.47, "10th_percentile": 55.47, "90th_percentile": 55.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 69.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $69.34 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 69.34, "10th_percentile": 69.34, "90th_percentile": 69.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $69.34 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 16.16, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 16.16, "10th_percentile": 16.16, "90th_percentile": 16.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 55.47, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 55.47, "10th_percentile": 55.47, "90th_percentile": 55.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 69.34, "10th_percentile": 69.34, "90th_percentile": 69.34, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 69.34, "10th_percentile": 69.34, "90th_percentile": 69.34, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 69.34, "10th_percentile": 69.34, "90th_percentile": 69.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 69.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 69.34, "10th_percentile": 69.34, "90th_percentile": 69.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "5Fr MPA1 0.038\" x 125cm Diagnostic Catheter", "code_information": [ { "code": "SUP-314423", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 48.43, "maximum": 646.17, "setting": "outpatient", "gross_charge": 231.8, "discounted_cash": 162.26, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 249.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 376.57, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 473.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 530.96, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 646.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 249.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 376.57, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 473.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 530.96, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 646.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 249.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 376.57, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 473.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 530.96, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 646.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 249.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 376.57, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 473.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 530.96, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 646.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 249.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 376.57, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 473.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 530.96, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 646.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 646.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 530.96, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 473.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 376.57, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 249.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 646.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 502.23, "10th_percentile": 405.65, "90th_percentile": 611.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 530.96, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 502.23, "10th_percentile": 405.65, "90th_percentile": 611.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 473.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 502.23, "10th_percentile": 405.65, "90th_percentile": 611.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 376.57, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 502.23, "10th_percentile": 405.65, "90th_percentile": 611.61, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 646.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 473.5, "10th_percentile": 289.71, "90th_percentile": 600.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 530.96, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 473.5, "10th_percentile": 289.71, "90th_percentile": 600.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 473.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 473.5, "10th_percentile": 289.71, "90th_percentile": 600.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 376.57, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 473.5, "10th_percentile": 289.71, "90th_percentile": 600.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 473.5, "10th_percentile": 289.71, "90th_percentile": 600.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 646.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 530.96, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 473.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 376.57, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 249.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 231.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 425.03, "10th_percentile": 240.72, "90th_percentile": 588.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 169.46, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 226.0, "10th_percentile": 182.55, "90th_percentile": 275.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 213.08, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 226.0, "10th_percentile": 182.55, "90th_percentile": 275.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 238.93, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 226.0, "10th_percentile": 182.55, "90th_percentile": 275.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 290.78, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 226.0, "10th_percentile": 182.55, "90th_percentile": 275.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 169.46, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 226.0, "10th_percentile": 182.55, "90th_percentile": 275.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 213.08, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 226.0, "10th_percentile": 182.55, "90th_percentile": 275.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 238.93, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 226.0, "10th_percentile": 182.55, "90th_percentile": 275.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 290.78, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 226.0, "10th_percentile": 182.55, "90th_percentile": 275.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 290.78, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 213.08, "10th_percentile": 135.18, "90th_percentile": 270.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 238.93, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 213.08, "10th_percentile": 135.18, "90th_percentile": 270.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 213.08, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 213.08, "10th_percentile": 135.18, "90th_percentile": 270.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 169.46, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 213.08, "10th_percentile": 135.18, "90th_percentile": 270.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 112.33, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 213.08, "10th_percentile": 135.18, "90th_percentile": 270.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 62.59, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 114.76, "10th_percentile": 65.0, "90th_percentile": 158.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 67.4, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 114.76, "10th_percentile": 65.0, "90th_percentile": 158.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 101.67, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 114.76, "10th_percentile": 65.0, "90th_percentile": 158.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 127.85, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 114.76, "10th_percentile": 65.0, "90th_percentile": 158.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 143.36, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 114.76, "10th_percentile": 65.0, "90th_percentile": 158.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 174.47, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 114.76, "10th_percentile": 65.0, "90th_percentile": 158.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 101.67, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 135.61, "10th_percentile": 109.52, "90th_percentile": 165.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 127.85, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 135.61, "10th_percentile": 109.52, "90th_percentile": 165.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 143.36, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 135.61, "10th_percentile": 109.52, "90th_percentile": 165.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 174.47, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 135.61, "10th_percentile": 109.52, "90th_percentile": 165.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 188.29, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 251.12, "10th_percentile": 202.83, "90th_percentile": 305.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 236.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 251.12, "10th_percentile": 202.83, "90th_percentile": 305.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 265.48, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 251.12, "10th_percentile": 202.83, "90th_percentile": 305.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 323.09, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 251.12, "10th_percentile": 202.83, "90th_percentile": 305.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 124.82, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 236.75, "10th_percentile": 150.21, "90th_percentile": 300.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 188.29, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 236.75, "10th_percentile": 150.21, "90th_percentile": 300.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 236.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 236.75, "10th_percentile": 150.21, "90th_percentile": 300.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 265.48, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 236.75, "10th_percentile": 150.21, "90th_percentile": 300.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 323.09, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 236.75, "10th_percentile": 150.21, "90th_percentile": 300.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 88.12, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 117.52, "10th_percentile": 94.92, "90th_percentile": 143.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 110.8, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 117.52, "10th_percentile": 94.92, "90th_percentile": 143.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 124.24, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 117.52, "10th_percentile": 94.92, "90th_percentile": 143.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 151.2, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 117.52, "10th_percentile": 94.92, "90th_percentile": 143.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 218.41, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 291.29, "10th_percentile": 235.28, "90th_percentile": 354.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 274.63, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 291.29, "10th_percentile": 235.28, "90th_percentile": 354.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 307.96, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 291.29, "10th_percentile": 235.28, "90th_percentile": 354.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 374.78, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 291.29, "10th_percentile": 235.28, "90th_percentile": 354.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 263.6, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 351.56, "10th_percentile": 283.96, "90th_percentile": 428.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 331.45, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 351.56, "10th_percentile": 283.96, "90th_percentile": 428.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 371.67, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 351.56, "10th_percentile": 283.96, "90th_percentile": 428.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 452.32, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 351.56, "10th_percentile": 283.96, "90th_percentile": 428.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 99.85, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 99.85, "10th_percentile": 99.85, "90th_percentile": 99.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 99.85, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 99.85, "10th_percentile": 99.85, "90th_percentile": 99.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 88.12, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 88.12, "10th_percentile": 88.12, "90th_percentile": 88.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 204.7, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 204.7, "10th_percentile": 204.7, "90th_percentile": 204.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 74.89, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 74.89, "10th_percentile": 74.89, "90th_percentile": 74.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 124.82, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 124.82, "10th_percentile": 124.82, "90th_percentile": 124.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 145.53, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 145.53, "10th_percentile": 145.53, "90th_percentile": 145.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 79.88, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 79.88, "10th_percentile": 79.88, "90th_percentile": 79.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 161.76, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 161.76, "10th_percentile": 161.76, "90th_percentile": 161.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 145.04, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 145.04, "10th_percentile": 145.04, "90th_percentile": 145.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 48.43, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 48.43, "10th_percentile": 48.43, "90th_percentile": 48.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 249.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 249.63, "10th_percentile": 249.63, "90th_percentile": 249.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 212.19, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 212.19, "10th_percentile": 212.19, "90th_percentile": 212.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 162.26, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 162.26, "10th_percentile": 162.26, "90th_percentile": 162.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 199.7, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 199.7, "10th_percentile": 199.7, "90th_percentile": 199.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 249.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $249.63 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 249.63, "10th_percentile": 249.63, "90th_percentile": 249.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $249.63 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 249.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 249.63, "10th_percentile": 249.63, "90th_percentile": 249.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 58.16, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 58.16, "10th_percentile": 58.16, "90th_percentile": 58.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 199.7, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 199.7, "10th_percentile": 199.7, "90th_percentile": 199.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 249.63, "10th_percentile": 249.63, "90th_percentile": 249.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 249.63, "10th_percentile": 249.63, "90th_percentile": 249.63, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 249.63, "10th_percentile": 249.63, "90th_percentile": 249.63, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" } ] } ] }, { "description": "6.5 HEALIX ADVANCE BR W OCORD", "code_information": [ { "code": "SUP-312486", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 188.85, "maximum": 2762.11, "setting": "outpatient", "gross_charge": 807.06, "discounted_cash": 564.94, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 217.91, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 379.13, "10th_percentile": 262.06, "90th_percentile": 639.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 365.08, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 379.13, "10th_percentile": 262.06, "90th_percentile": 639.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 393.17, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 379.13, "10th_percentile": 262.06, "90th_percentile": 639.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 745.77, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 379.13, "10th_percentile": 262.06, "90th_percentile": 639.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 217.91, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 481.84, "10th_percentile": 270.7, "90th_percentile": 692.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 745.77, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 481.84, "10th_percentile": 270.7, "90th_percentile": 692.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1381.06, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1381.06, "10th_percentile": 1381.06, "90th_percentile": 1381.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 728.09, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1054.58, "10th_percentile": 793.39, "90th_percentile": 1315.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1381.06, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1054.58, "10th_percentile": 793.39, "90th_percentile": 1315.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 188.85, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 417.59, "10th_percentile": 234.6, "90th_percentile": 600.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 646.33, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 417.59, "10th_percentile": 234.6, "90th_percentile": 600.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1602.02, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1602.02, "10th_percentile": 1602.02, "90th_percentile": 1602.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1933.48, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1933.48, "10th_percentile": 1933.48, "90th_percentile": 1933.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1242.95, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1242.95, "10th_percentile": 1242.95, "90th_percentile": 1242.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 655.28, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 949.12, "10th_percentile": 714.05, "90th_percentile": 1184.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1242.95, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 949.12, "10th_percentile": 714.05, "90th_percentile": 1184.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 1242.95, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1242.95, "10th_percentile": 1242.95, "90th_percentile": 1242.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1352.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1456.18, "10th_percentile": 1372.95, "90th_percentile": 2500.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1456.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1456.18, "10th_percentile": 1372.95, "90th_percentile": 2500.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2762.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1456.18, "10th_percentile": 1372.95, "90th_percentile": 2500.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2762.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2762.11, "10th_percentile": 2762.11, "90th_percentile": 2762.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1352.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2057.13, "10th_percentile": 1493.14, "90th_percentile": 2621.11, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2762.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2057.13, "10th_percentile": 1493.14, "90th_percentile": 2621.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1352.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1456.18, "10th_percentile": 1372.95, "90th_percentile": 2500.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1456.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1456.18, "10th_percentile": 1372.95, "90th_percentile": 2500.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2762.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1456.18, "10th_percentile": 1372.95, "90th_percentile": 2500.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1352.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1456.18, "10th_percentile": 1372.95, "90th_percentile": 2500.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1456.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1456.18, "10th_percentile": 1372.95, "90th_percentile": 2500.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2762.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1456.18, "10th_percentile": 1372.95, "90th_percentile": 2500.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2762.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1456.18, "10th_percentile": 1372.95, "90th_percentile": 2500.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1456.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1456.18, "10th_percentile": 1372.95, "90th_percentile": 2500.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1352.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1456.18, "10th_percentile": 1372.95, "90th_percentile": 2500.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1352.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1456.18, "10th_percentile": 1372.95, "90th_percentile": 2500.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1456.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1456.18, "10th_percentile": 1372.95, "90th_percentile": 2500.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2762.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1456.18, "10th_percentile": 1372.95, "90th_percentile": 2500.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2762.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1456.18, "10th_percentile": 1372.95, "90th_percentile": 2500.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1456.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1456.18, "10th_percentile": 1372.95, "90th_percentile": 2500.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1352.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1456.18, "10th_percentile": 1372.95, "90th_percentile": 2500.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2762.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1456.18, "10th_percentile": 1372.95, "90th_percentile": 2500.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1456.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1456.18, "10th_percentile": 1372.95, "90th_percentile": 2500.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1352.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1456.18, "10th_percentile": 1372.95, "90th_percentile": 2500.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 339.29, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 943.6, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 436.85, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 846.04, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 282.5, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1456.18, "10th_percentile": 1456.18, "90th_percentile": 1456.18, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 1456.18, "10th_percentile": 1456.18, "90th_percentile": 1456.18, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 1456.18, "10th_percentile": 1456.18, "90th_percentile": 1456.18, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 1164.94, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 1456.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,456.18 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1456.18, "10th_percentile": 1456.18, "90th_percentile": 1456.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,456.18 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1456.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1456.18, "10th_percentile": 1456.18, "90th_percentile": 1456.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 1164.94, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 1164.94, "10th_percentile": 1164.94, "90th_percentile": 1164.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 946.52, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 946.52, "10th_percentile": 946.52, "90th_percentile": 946.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 728.09, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 728.09, "10th_percentile": 728.09, "90th_percentile": 728.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 465.98, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 465.98, "10th_percentile": 465.98, "90th_percentile": 465.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 1237.75, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 1237.75, "10th_percentile": 1237.75, "90th_percentile": 1237.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1456.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1456.18, "10th_percentile": 1456.18, "90th_percentile": 1456.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 1194.07, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 1194.07, "10th_percentile": 1194.07, "90th_percentile": 1194.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 848.95, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 848.95, "10th_percentile": 848.95, "90th_percentile": 848.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 514.03, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 514.03, "10th_percentile": 514.03, "90th_percentile": 514.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 582.47, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 582.47, "10th_percentile": 582.47, "90th_percentile": 582.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 582.47, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 582.47, "10th_percentile": 582.47, "90th_percentile": 582.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" } ] } ] }, { "description": "6F 13CM INTRO SYS W/INFUS SIDE PORT SAFESHEATH II", "code_information": [ { "code": "SUP-358902", "type": "CDM" }, { "code": "C1892", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 68.52, "maximum": 914.21, "setting": "outpatient", "gross_charge": 532.78, "discounted_cash": 372.95, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 239.75, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 319.75, "10th_percentile": 258.26, "90th_percentile": 389.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 301.46, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 319.75, "10th_percentile": 258.26, "90th_percentile": 389.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 338.04, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 319.75, "10th_percentile": 258.26, "90th_percentile": 389.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 411.39, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 319.75, "10th_percentile": 258.26, "90th_percentile": 389.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 239.75, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 319.75, "10th_percentile": 258.26, "90th_percentile": 389.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 301.46, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 319.75, "10th_percentile": 258.26, "90th_percentile": 389.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 338.04, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 319.75, "10th_percentile": 258.26, "90th_percentile": 389.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 411.39, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 319.75, "10th_percentile": 258.26, "90th_percentile": 389.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 158.93, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 301.46, "10th_percentile": 191.26, "90th_percentile": 382.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 239.75, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 301.46, "10th_percentile": 191.26, "90th_percentile": 382.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 301.46, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 301.46, "10th_percentile": 191.26, "90th_percentile": 382.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 338.04, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 301.46, "10th_percentile": 191.26, "90th_percentile": 382.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 411.39, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 301.46, "10th_percentile": 191.26, "90th_percentile": 382.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 246.84, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 191.85, "10th_percentile": 154.96, "90th_percentile": 233.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 202.82, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 191.85, "10th_percentile": 154.96, "90th_percentile": 233.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 180.88, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 191.85, "10th_percentile": 154.96, "90th_percentile": 233.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 143.85, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 191.85, "10th_percentile": 154.96, "90th_percentile": 233.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 95.36, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 180.88, "10th_percentile": 114.76, "90th_percentile": 229.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 143.85, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 180.88, "10th_percentile": 114.76, "90th_percentile": 229.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 180.88, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 180.88, "10th_percentile": 114.76, "90th_percentile": 229.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 202.82, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 180.88, "10th_percentile": 114.76, "90th_percentile": 229.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 246.84, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 180.88, "10th_percentile": 114.76, "90th_percentile": 229.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 457.11, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 355.28, "10th_percentile": 286.96, "90th_percentile": 432.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 375.6, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 355.28, "10th_percentile": 286.96, "90th_percentile": 432.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 334.96, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 355.28, "10th_percentile": 286.96, "90th_percentile": 432.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 266.39, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 355.28, "10th_percentile": 286.96, "90th_percentile": 432.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 176.59, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 334.96, "10th_percentile": 212.51, "90th_percentile": 424.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 266.39, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 334.96, "10th_percentile": 212.51, "90th_percentile": 424.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 334.96, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 334.96, "10th_percentile": 212.51, "90th_percentile": 424.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 375.6, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 334.96, "10th_percentile": 212.51, "90th_percentile": 424.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 457.11, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 334.96, "10th_percentile": 212.51, "90th_percentile": 424.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 213.93, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 166.27, "10th_percentile": 134.3, "90th_percentile": 202.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 175.78, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 166.27, "10th_percentile": 134.3, "90th_percentile": 202.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 156.76, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 166.27, "10th_percentile": 134.3, "90th_percentile": 202.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 124.67, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 166.27, "10th_percentile": 134.3, "90th_percentile": 202.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 530.24, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 412.13, "10th_percentile": 332.87, "90th_percentile": 501.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 435.7, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 412.13, "10th_percentile": 332.87, "90th_percentile": 501.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 388.55, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 412.13, "10th_percentile": 332.87, "90th_percentile": 501.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 309.01, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 412.13, "10th_percentile": 332.87, "90th_percentile": 501.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 372.95, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 497.39, "10th_percentile": 401.75, "90th_percentile": 605.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 468.94, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 497.39, "10th_percentile": 401.75, "90th_percentile": 605.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 525.84, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 497.39, "10th_percentile": 401.75, "90th_percentile": 605.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 639.95, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 497.39, "10th_percentile": 401.75, "90th_percentile": 605.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 914.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 751.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 669.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 532.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 353.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 914.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 751.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 669.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 532.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 353.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 353.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 532.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 669.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 751.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 914.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 353.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 532.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 669.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 751.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 914.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 914.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 751.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 669.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 532.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 353.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 353.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 532.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 669.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 751.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 914.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 353.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 532.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 669.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 751.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 914.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 425.02, "90th_percentile": 849.01, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 914.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 710.56, "10th_percentile": 573.92, "90th_percentile": 865.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 751.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 710.56, "10th_percentile": 573.92, "90th_percentile": 865.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 669.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 710.56, "10th_percentile": 573.92, "90th_percentile": 865.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 532.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 710.56, "10th_percentile": 573.92, "90th_percentile": 865.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 914.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 710.56, "10th_percentile": 573.92, "90th_percentile": 865.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 751.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 710.56, "10th_percentile": 573.92, "90th_percentile": 865.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 669.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 710.56, "10th_percentile": 573.92, "90th_percentile": 865.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 532.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 710.56, "10th_percentile": 573.92, "90th_percentile": 865.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 117.52, "10th_percentile": 117.52, "90th_percentile": 117.52, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 353.18, "10th_percentile": 353.18, "90th_percentile": 353.18, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 353.18, "10th_percentile": 353.18, "90th_percentile": 353.18, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 228.86, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 166.03, "10th_percentile": 166.03, "90th_percentile": 166.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 205.2, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 205.2, "10th_percentile": 205.2, "90th_percentile": 205.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 353.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $353.18 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 353.18, "10th_percentile": 353.18, "90th_percentile": 353.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $353.18 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 82.29, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 82.29, "10th_percentile": 82.29, "90th_percentile": 82.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 282.54, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 282.54, "10th_percentile": 282.54, "90th_percentile": 282.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 176.59, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 176.59, "10th_percentile": 176.59, "90th_percentile": 176.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 205.9, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 205.9, "10th_percentile": 205.9, "90th_percentile": 205.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMH PHCS PPO", "standard_charge_dollar": 282.54, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 282.54, "10th_percentile": 282.54, "90th_percentile": 282.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 353.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 353.18, "10th_percentile": 353.18, "90th_percentile": 353.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 229.57, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 229.57, "10th_percentile": 229.57, "90th_percentile": 229.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 289.61, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 289.61, "10th_percentile": 289.61, "90th_percentile": 289.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 300.2, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 300.2, "10th_percentile": 300.2, "90th_percentile": 300.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 113.02, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 113.02, "10th_percentile": 113.02, "90th_percentile": 113.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 124.67, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 124.67, "10th_percentile": 124.67, "90th_percentile": 124.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 105.95, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 105.95, "10th_percentile": 105.95, "90th_percentile": 105.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 68.52, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 68.52, "10th_percentile": 68.52, "90th_percentile": 68.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 141.27, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 141.27, "10th_percentile": 141.27, "90th_percentile": 141.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 141.27, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 141.27, "10th_percentile": 141.27, "90th_percentile": 141.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 353.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 353.18, "10th_percentile": 353.18, "90th_percentile": 353.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "6FR SAFE SHEATH II HEMOSTATIC TEAR AWAY INTRODUCER SYSTEM WITH INFUSION SIDE PORT", "code_information": [ { "code": "SUP-357878", "type": "CDM" }, { "code": "C1894", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 84.06, "maximum": 1794.92, "setting": "outpatient", "gross_charge": 1315.29, "discounted_cash": 920.7, "payers_information": [ { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 920.7, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1088.57, "10th_percentile": 954.27, "90th_percentile": 1222.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1256.44, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1088.57, "10th_percentile": 954.27, "90th_percentile": 1222.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 762.87, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 901.96, "10th_percentile": 790.69, "90th_percentile": 1013.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1041.05, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 901.96, "10th_percentile": 790.69, "90th_percentile": 1013.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 420.01, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 307.78, "10th_percentile": 128.8, "90th_percentile": 397.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 307.78, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 307.78, "10th_percentile": 128.8, "90th_percentile": 397.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 84.06, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 307.78, "10th_percentile": 128.8, "90th_percentile": 397.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 657.65, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 777.56, "10th_percentile": 681.63, "90th_percentile": 873.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 897.46, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 777.56, "10th_percentile": 681.63, "90th_percentile": 873.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 346.71, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 657.65, "10th_percentile": 188.48, "90th_percentile": 849.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 657.65, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 657.65, "10th_percentile": 188.48, "90th_percentile": 849.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 897.46, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 657.65, "10th_percentile": 188.48, "90th_percentile": 849.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 97.0, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 355.13, "10th_percentile": 148.63, "90th_percentile": 458.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 355.13, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 355.13, "10th_percentile": 148.63, "90th_percentile": 458.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 484.63, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 355.13, "10th_percentile": 148.63, "90th_percentile": 458.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 484.63, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 187.22, "10th_percentile": 127.74, "90th_percentile": 432.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 355.13, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 187.22, "10th_percentile": 127.74, "90th_percentile": 432.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 187.22, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 187.22, "10th_percentile": 127.74, "90th_percentile": 432.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 173.85, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 187.22, "10th_percentile": 127.74, "90th_percentile": 432.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 97.0, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 187.22, "10th_percentile": 127.74, "90th_percentile": 432.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 591.88, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 699.8, "10th_percentile": 613.46, "90th_percentile": 786.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 807.71, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 699.8, "10th_percentile": 613.46, "90th_percentile": 786.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 591.88, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 699.8, "10th_percentile": 613.46, "90th_percentile": 786.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 807.71, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 699.8, "10th_percentile": 613.46, "90th_percentile": 786.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 807.71, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 591.88, "10th_percentile": 368.01, "90th_percentile": 764.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 591.88, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 591.88, "10th_percentile": 368.01, "90th_percentile": 764.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 312.04, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 591.88, "10th_percentile": 368.01, "90th_percentile": 764.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1794.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1315.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 693.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 643.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1315.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1555.11, "10th_percentile": 1363.25, "90th_percentile": 1746.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1794.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1555.11, "10th_percentile": 1363.25, "90th_percentile": 1746.96, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1794.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1315.29, "10th_percentile": 778.16, "90th_percentile": 1698.99, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1315.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1315.29, "10th_percentile": 778.16, "90th_percentile": 1698.99, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 643.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1315.29, "10th_percentile": 778.16, "90th_percentile": 1698.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 643.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 693.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1315.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1794.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1794.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1315.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 693.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 643.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1794.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1315.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 693.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 643.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 643.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 693.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1315.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1794.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 643.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 693.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1315.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1794.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 643.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 693.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1315.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1794.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.36, "10th_percentile": 658.74, "90th_percentile": 1651.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 161.57, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 58.54, "10th_percentile": 58.54, "90th_percentile": 58.54, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 402.88, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 128.67, "10th_percentile": 128.67, "90th_percentile": 128.67, "count": "15", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 449.34, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 110.54, "10th_percentile": 110.54, "90th_percentile": 110.54, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 117.8, "10th_percentile": 117.8, "90th_percentile": 117.8, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 83.03, "10th_percentile": 83.03, "90th_percentile": 83.03, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 693.42, "10th_percentile": 693.42, "90th_percentile": 693.42, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 693.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $693.42 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 693.42, "10th_percentile": 693.42, "90th_percentile": 693.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $693.42 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 554.74, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 554.74, "10th_percentile": 554.74, "90th_percentile": 554.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 346.71, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 346.71, "10th_percentile": 346.71, "90th_percentile": 346.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 404.26, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 110.88, "10th_percentile": 110.88, "90th_percentile": 110.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMH PHCS PPO", "standard_charge_dollar": 554.74, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 554.74, "10th_percentile": 554.74, "90th_percentile": 554.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 693.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 693.42, "10th_percentile": 693.42, "90th_percentile": 693.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 450.72, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 450.72, "10th_percentile": 450.72, "90th_percentile": 450.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 568.6, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 568.6, "10th_percentile": 568.6, "90th_percentile": 568.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 589.41, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 589.41, "10th_percentile": 589.41, "90th_percentile": 589.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 221.89, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 221.89, "10th_percentile": 221.89, "90th_percentile": 221.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 244.78, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 244.78, "10th_percentile": 244.78, "90th_percentile": 244.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 208.03, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 208.03, "10th_percentile": 208.03, "90th_percentile": 208.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 134.52, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 134.52, "10th_percentile": 134.52, "90th_percentile": 134.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 277.37, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 277.37, "10th_percentile": 277.37, "90th_percentile": 277.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 277.37, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 277.37, "10th_percentile": 277.37, "90th_percentile": 277.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 693.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 693.42, "10th_percentile": 693.42, "90th_percentile": 693.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "6FR X 110CM TUOHY BORST SIDE ARM INTRODUCER FLEXOR SHUTTLE", "code_information": [ { "code": "SUP-365344", "type": "CDM" }, { "code": "C1894", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 92.82, "maximum": 907.55, "setting": "outpatient", "gross_charge": 907.55, "discounted_cash": 635.28, "payers_information": [ { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 635.29, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 635.29, "10th_percentile": 635.29, "90th_percentile": 635.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 526.38, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 526.38, "10th_percentile": 526.38, "90th_percentile": 526.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 212.37, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 212.37, "10th_percentile": 212.37, "90th_percentile": 212.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 453.78, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 453.78, "10th_percentile": 453.78, "90th_percentile": 453.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 239.23, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 262.49, "10th_percentile": 109.45, "90th_percentile": 415.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 453.78, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 262.49, "10th_percentile": 109.45, "90th_percentile": 415.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 245.04, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.04, "10th_percentile": 245.04, "90th_percentile": 245.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 119.95, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 129.18, "10th_percentile": 121.8, "90th_percentile": 221.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 129.18, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 129.18, "10th_percentile": 121.8, "90th_percentile": 221.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 245.04, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 129.18, "10th_percentile": 121.8, "90th_percentile": 221.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 408.4, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 408.4, "10th_percentile": 408.4, "90th_percentile": 408.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 408.4, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 408.4, "10th_percentile": 408.4, "90th_percentile": 408.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 215.31, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 311.86, "10th_percentile": 234.62, "90th_percentile": 389.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 408.4, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 311.86, "10th_percentile": 234.62, "90th_percentile": 389.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 907.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 478.46, "10th_percentile": 451.11, "90th_percentile": 821.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 478.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 478.46, "10th_percentile": 451.11, "90th_percentile": 821.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 444.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 478.46, "10th_percentile": 451.11, "90th_percentile": 821.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 907.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 907.55, "10th_percentile": 907.55, "90th_percentile": 907.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 444.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 675.91, "10th_percentile": 490.6, "90th_percentile": 861.22, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 907.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 675.91, "10th_percentile": 490.6, "90th_percentile": 861.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 444.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 478.46, "10th_percentile": 451.11, "90th_percentile": 821.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 478.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 478.46, "10th_percentile": 451.11, "90th_percentile": 821.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 907.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 478.46, "10th_percentile": 451.11, "90th_percentile": 821.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 444.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 478.46, "10th_percentile": 451.11, "90th_percentile": 821.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 478.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 478.46, "10th_percentile": 451.11, "90th_percentile": 821.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 907.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 478.46, "10th_percentile": 451.11, "90th_percentile": 821.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 444.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 478.46, "10th_percentile": 451.11, "90th_percentile": 821.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 478.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 478.46, "10th_percentile": 451.11, "90th_percentile": 821.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 907.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 478.46, "10th_percentile": 451.11, "90th_percentile": 821.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 907.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 478.46, "10th_percentile": 451.11, "90th_percentile": 821.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 478.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 478.46, "10th_percentile": 451.11, "90th_percentile": 821.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 444.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 478.46, "10th_percentile": 451.11, "90th_percentile": 821.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 907.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 478.46, "10th_percentile": 451.11, "90th_percentile": 821.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 478.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 478.46, "10th_percentile": 451.11, "90th_percentile": 821.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 444.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 478.46, "10th_percentile": 451.11, "90th_percentile": 821.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 444.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 478.46, "10th_percentile": 451.11, "90th_percentile": 821.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 478.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 478.46, "10th_percentile": 451.11, "90th_percentile": 821.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 907.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 478.46, "10th_percentile": 451.11, "90th_percentile": 821.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 111.48, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 58.54, "10th_percentile": 58.54, "90th_percentile": 58.54, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 277.99, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 128.67, "10th_percentile": 128.67, "90th_percentile": 128.67, "count": "15", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 310.04, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 110.54, "10th_percentile": 110.54, "90th_percentile": 110.54, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 117.8, "10th_percentile": 117.8, "90th_percentile": 117.8, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 83.03, "10th_percentile": 83.03, "90th_percentile": 83.03, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 478.46, "10th_percentile": 478.46, "90th_percentile": 478.46, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 478.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $478.46 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 478.46, "10th_percentile": 478.46, "90th_percentile": 478.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $478.46 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 382.77, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 382.77, "10th_percentile": 382.77, "90th_percentile": 382.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 239.23, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 239.23, "10th_percentile": 239.23, "90th_percentile": 239.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 278.94, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 110.88, "10th_percentile": 110.88, "90th_percentile": 110.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMH PHCS PPO", "standard_charge_dollar": 382.77, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 382.77, "10th_percentile": 382.77, "90th_percentile": 382.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 478.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 478.46, "10th_percentile": 478.46, "90th_percentile": 478.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 311.0, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 311.0, "10th_percentile": 311.0, "90th_percentile": 311.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 392.34, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 392.34, "10th_percentile": 392.34, "90th_percentile": 392.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 406.69, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 406.69, "10th_percentile": 406.69, "90th_percentile": 406.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 153.11, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 153.11, "10th_percentile": 153.11, "90th_percentile": 153.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 168.9, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 168.9, "10th_percentile": 168.9, "90th_percentile": 168.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 143.54, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 143.54, "10th_percentile": 143.54, "90th_percentile": 143.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 92.82, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 92.82, "10th_percentile": 92.82, "90th_percentile": 92.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 191.38, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 191.38, "10th_percentile": 191.38, "90th_percentile": 191.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 191.38, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 191.38, "10th_percentile": 191.38, "90th_percentile": 191.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 478.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 478.46, "10th_percentile": 478.46, "90th_percentile": 478.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "ABSORBATACK 5MM LAP HERNIA FIXATION DEVICE (ABSTACK30X)", "code_information": [ { "code": "SUP-317207", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 820.38, "maximum": 5787.03, "setting": "outpatient", "gross_charge": 3038.45, "discounted_cash": 2126.91, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3038.45, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4772.4, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5722.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5787.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5722.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5787.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3038.45, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4772.4, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5722.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5787.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3038.45, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4772.4, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5722.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5787.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5787.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5722.21, "10th_percentile": 4962.36, "90th_percentile": 5774.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5722.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5722.21, "10th_percentile": 4962.36, "90th_percentile": 5774.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4772.4, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5722.21, "10th_percentile": 4962.36, "90th_percentile": 5774.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3038.45, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4772.4, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5722.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5787.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 3038.45, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 4772.4, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 5722.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 5787.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 5247.31, "10th_percentile": 3558.64, "90th_percentile": 5767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 2604.16, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2574.99, "10th_percentile": 2233.06, "90th_percentile": 2598.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 2574.99, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2574.99, "10th_percentile": 2233.06, "90th_percentile": 2598.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 2147.58, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2574.99, "10th_percentile": 2233.06, "90th_percentile": 2598.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2147.58, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2574.99, "10th_percentile": 2233.06, "90th_percentile": 2598.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2574.99, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2574.99, "10th_percentile": 2233.06, "90th_percentile": 2598.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2604.16, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2574.99, "10th_percentile": 2233.06, "90th_percentile": 2598.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2604.16, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2574.99, "10th_percentile": 2233.06, "90th_percentile": 2598.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2574.99, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2574.99, "10th_percentile": 2233.06, "90th_percentile": 2598.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2147.58, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2574.99, "10th_percentile": 2233.06, "90th_percentile": 2598.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 820.38, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1416.78, "10th_percentile": 960.83, "90th_percentile": 1557.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1288.55, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1416.78, "10th_percentile": 960.83, "90th_percentile": 1557.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1545.0, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1416.78, "10th_percentile": 960.83, "90th_percentile": 1557.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1562.5, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1416.78, "10th_percentile": 960.83, "90th_percentile": 1557.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1288.55, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1545.0, "10th_percentile": 1339.84, "90th_percentile": 1559.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1545.0, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1545.0, "10th_percentile": 1339.84, "90th_percentile": 1559.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1562.5, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1545.0, "10th_percentile": 1339.84, "90th_percentile": 1559.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2386.2, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2861.11, "10th_percentile": 2481.18, "90th_percentile": 2887.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2861.11, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2861.11, "10th_percentile": 2481.18, "90th_percentile": 2887.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2893.52, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2861.11, "10th_percentile": 2481.18, "90th_percentile": 2887.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2386.2, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2861.11, "10th_percentile": 2481.18, "90th_percentile": 2887.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2861.11, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2861.11, "10th_percentile": 2481.18, "90th_percentile": 2887.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2893.52, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2861.11, "10th_percentile": 2481.18, "90th_percentile": 2887.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1116.74, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1339.0, "10th_percentile": 1161.19, "90th_percentile": 1351.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1339.0, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1339.0, "10th_percentile": 1161.19, "90th_percentile": 1351.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1354.17, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1339.0, "10th_percentile": 1161.19, "90th_percentile": 1351.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 2767.99, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 3318.88, "10th_percentile": 2878.17, "90th_percentile": 3348.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 3318.88, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 3318.88, "10th_percentile": 2878.17, "90th_percentile": 3348.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 3356.48, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 3318.88, "10th_percentile": 2878.17, "90th_percentile": 3348.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 3340.68, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 4005.55, "10th_percentile": 3473.65, "90th_percentile": 4041.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 4005.55, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 4005.55, "10th_percentile": 3473.65, "90th_percentile": 4041.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 4050.92, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 4005.55, "10th_percentile": 3473.65, "90th_percentile": 4041.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" } ] } ] }, { "description": "ACCESSORY KT ARTHSCP ANT CRUC LIG ACL DISP", "code_information": [ { "code": "SUP-126551", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 304.87, "maximum": 4770.12, "setting": "outpatient", "gross_charge": 1302.88, "discounted_cash": 912.02, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 351.78, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 654.74, "10th_percentile": 435.39, "90th_percentile": 1105.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 630.48, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 654.74, "10th_percentile": 435.39, "90th_percentile": 1105.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 679.0, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 654.74, "10th_percentile": 435.39, "90th_percentile": 1105.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1287.93, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 654.74, "10th_percentile": 435.39, "90th_percentile": 1105.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1287.93, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 819.86, "10th_percentile": 445.4, "90th_percentile": 1194.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 351.78, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 819.86, "10th_percentile": 445.4, "90th_percentile": 1194.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2385.06, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2385.06, "10th_percentile": 2385.06, "90th_percentile": 2385.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1257.4, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1821.23, "10th_percentile": 1370.17, "90th_percentile": 2272.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2385.06, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1821.23, "10th_percentile": 1370.17, "90th_percentile": 2272.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 304.87, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 710.54, "10th_percentile": 386.0, "90th_percentile": 1035.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1116.21, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 710.54, "10th_percentile": 386.0, "90th_percentile": 1035.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 2766.67, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 2766.67, "10th_percentile": 2766.67, "90th_percentile": 2766.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 3339.08, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 3339.08, "10th_percentile": 3339.08, "90th_percentile": 3339.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2146.55, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2146.55, "10th_percentile": 2146.55, "90th_percentile": 2146.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1131.66, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1639.11, "10th_percentile": 1233.15, "90th_percentile": 2045.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2146.55, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1639.11, "10th_percentile": 1233.15, "90th_percentile": 2045.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 2146.55, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2146.55, "10th_percentile": 2146.55, "90th_percentile": 2146.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2335.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 2514.8, "10th_percentile": 2371.06, "90th_percentile": 4319.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2514.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 2514.8, "10th_percentile": 2371.06, "90th_percentile": 4319.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 4770.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 2514.8, "10th_percentile": 2371.06, "90th_percentile": 4319.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4770.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4770.12, "10th_percentile": 4770.12, "90th_percentile": 4770.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4770.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3552.62, "10th_percentile": 2578.62, "90th_percentile": 4526.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2335.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3552.62, "10th_percentile": 2578.62, "90th_percentile": 4526.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2335.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2514.8, "10th_percentile": 2371.06, "90th_percentile": 4319.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2514.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2514.8, "10th_percentile": 2371.06, "90th_percentile": 4319.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4770.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2514.8, "10th_percentile": 2371.06, "90th_percentile": 4319.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4770.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2514.8, "10th_percentile": 2371.06, "90th_percentile": 4319.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2514.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2514.8, "10th_percentile": 2371.06, "90th_percentile": 4319.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2335.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2514.8, "10th_percentile": 2371.06, "90th_percentile": 4319.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2335.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2514.8, "10th_percentile": 2371.06, "90th_percentile": 4319.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2514.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2514.8, "10th_percentile": 2371.06, "90th_percentile": 4319.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4770.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2514.8, "10th_percentile": 2371.06, "90th_percentile": 4319.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2335.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2514.8, "10th_percentile": 2371.06, "90th_percentile": 4319.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2514.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2514.8, "10th_percentile": 2371.06, "90th_percentile": 4319.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4770.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2514.8, "10th_percentile": 2371.06, "90th_percentile": 4319.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4770.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2514.8, "10th_percentile": 2371.06, "90th_percentile": 4319.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2514.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2514.8, "10th_percentile": 2371.06, "90th_percentile": 4319.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2335.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2514.8, "10th_percentile": 2371.06, "90th_percentile": 4319.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2335.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2514.8, "10th_percentile": 2371.06, "90th_percentile": 4319.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2514.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2514.8, "10th_percentile": 2371.06, "90th_percentile": 4319.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4770.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2514.8, "10th_percentile": 2371.06, "90th_percentile": 4319.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 585.95, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.31, "10th_percentile": 245.31, "90th_percentile": 245.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 1629.59, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 551.22, "10th_percentile": 551.22, "90th_percentile": 551.22, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 754.44, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 196.46, "10th_percentile": 196.46, "90th_percentile": 196.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 1461.1, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 886.17, "10th_percentile": 886.17, "90th_percentile": 886.17, "count": "21", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 487.87, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 383.77, "10th_percentile": 383.77, "90th_percentile": 383.77, "count": "33", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2514.8, "10th_percentile": 2514.8, "90th_percentile": 2514.8, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 2514.8, "10th_percentile": 2514.8, "90th_percentile": 2514.8, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 2514.8, "10th_percentile": 2514.8, "90th_percentile": 2514.8, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 2011.84, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3987.86, "10th_percentile": 3987.86, "90th_percentile": 3987.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 2514.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2,514.80 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 2514.8, "10th_percentile": 2514.8, "90th_percentile": 2514.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2,514.80 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2514.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2514.8, "10th_percentile": 2514.8, "90th_percentile": 2514.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 2011.84, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 2011.84, "10th_percentile": 2011.84, "90th_percentile": 2011.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1634.62, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 1634.62, "10th_percentile": 1634.62, "90th_percentile": 1634.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 1257.4, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1257.4, "10th_percentile": 1257.4, "90th_percentile": 1257.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 804.74, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 804.74, "10th_percentile": 804.74, "90th_percentile": 804.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 2137.58, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 2137.58, "10th_percentile": 2137.58, "90th_percentile": 2137.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2514.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2514.8, "10th_percentile": 2514.8, "90th_percentile": 2514.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 2062.14, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 2062.14, "10th_percentile": 2062.14, "90th_percentile": 2062.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 1466.13, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1466.13, "10th_percentile": 1466.13, "90th_percentile": 1466.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 887.72, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 887.72, "10th_percentile": 887.72, "90th_percentile": 887.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 1005.92, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 1005.92, "10th_percentile": 1005.92, "90th_percentile": 1005.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 1005.92, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 1005.92, "10th_percentile": 1005.92, "90th_percentile": 1005.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" } ] } ] }, { "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": 0.23, "maximum": 0.7, "setting": "outpatient", "gross_charge": 1.0, "discounted_cash": 0.7, "payers_information": [ { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.23, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 0.23, "10th_percentile": 0.23, "90th_percentile": 0.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 0.7, "10th_percentile": 0.7, "90th_percentile": 0.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" } ] } ] }, { "description": "ACETAMINOPHEN 32 MG/ML ORAL SUSP", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "RX-181460", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00121-1781-00", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.93, "maximum": 9.5, "setting": "outpatient", "gross_charge": 8.25, "discounted_cash": 5.77, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 8.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 3.71, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 3.77, "90th_percentile": 4.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 4.28, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 3.77, "90th_percentile": 4.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3.71, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 3.77, "90th_percentile": 4.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 4.28, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 3.77, "90th_percentile": 4.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3.71, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 3.77, "90th_percentile": 4.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 4.28, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 3.77, "90th_percentile": 4.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2.57, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": 2.26, "90th_percentile": 2.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2.23, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": 2.26, "90th_percentile": 2.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2.57, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": 2.26, "90th_percentile": 2.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2.23, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": 2.26, "90th_percentile": 2.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 4.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 4.44, "10th_percentile": 4.19, "90th_percentile": 4.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 4.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 4.44, "10th_percentile": 4.19, "90th_percentile": 4.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 4.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 4.44, "10th_percentile": 4.19, "90th_percentile": 4.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 4.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 4.44, "10th_percentile": 4.19, "90th_percentile": 4.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1.93, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 2.08, "10th_percentile": 1.96, "90th_percentile": 2.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 2.22, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 2.08, "10th_percentile": 1.96, "90th_percentile": 2.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 5.78, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 6.21, "10th_percentile": 5.87, "90th_percentile": 6.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 6.65, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 6.21, "10th_percentile": 5.87, "90th_percentile": 6.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 4.79, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 5.15, "10th_percentile": 4.86, "90th_percentile": 5.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 5.51, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 5.15, "10th_percentile": 4.86, "90th_percentile": 5.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" } ] } ] }, { "description": "ACETAMINOPHEN 32 MG/ML ORAL SUSP", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "RX-181460", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00121-1781-05", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.93, "maximum": 9.5, "setting": "outpatient", "gross_charge": 8.25, "discounted_cash": 5.77, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 8.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 9.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 8.88, "10th_percentile": 8.38, "90th_percentile": 9.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 4.28, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 3.77, "90th_percentile": 4.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 3.71, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 3.77, "90th_percentile": 4.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3.71, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 3.77, "90th_percentile": 4.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 4.28, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 3.77, "90th_percentile": 4.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3.71, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 3.77, "90th_percentile": 4.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 4.28, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 3.77, "90th_percentile": 4.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2.23, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": 2.26, "90th_percentile": 2.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2.57, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": 2.26, "90th_percentile": 2.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2.57, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": 2.26, "90th_percentile": 2.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2.23, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": 2.26, "90th_percentile": 2.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 4.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 4.44, "10th_percentile": 4.19, "90th_percentile": 4.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 4.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 4.44, "10th_percentile": 4.19, "90th_percentile": 4.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 4.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 4.44, "10th_percentile": 4.19, "90th_percentile": 4.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 4.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 4.44, "10th_percentile": 4.19, "90th_percentile": 4.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 2.22, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 2.08, "10th_percentile": 1.96, "90th_percentile": 2.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1.93, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 2.08, "10th_percentile": 1.96, "90th_percentile": 2.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 5.78, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 6.21, "10th_percentile": 5.87, "90th_percentile": 6.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 6.65, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 6.21, "10th_percentile": 5.87, "90th_percentile": 6.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 5.51, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 5.15, "10th_percentile": 4.86, "90th_percentile": 5.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 4.79, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 5.15, "10th_percentile": 4.86, "90th_percentile": 5.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" } ] } ] }, { "description": "ACETAMINOPHEN 325 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-101", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "57896-0102-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.54, "maximum": 2.0, "setting": "outpatient", "gross_charge": 2.0, "discounted_cash": 1.4, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC 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": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC 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": "HEALTHLINK [125]", "plan_name": "NMHC 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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 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 (Non-Contracted); 100% Billed" } ] } ] }, { "description": "ACETAMINOPHEN 325 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-101", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "71399-8025-02", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.47, "maximum": 0.54, "setting": "outpatient", "gross_charge": 2.0, "discounted_cash": 1.4, "payers_information": [ { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.47, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% 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 OP Services; 23.4% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "ACETAMINOPHEN 500 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-102", "type": "CDM" }, { "code": "CHRG1625", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "24385-0484-71", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.47, "maximum": 2.0, "setting": "outpatient", "gross_charge": 2.0, "discounted_cash": 1.4, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 0.9, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.9, "10th_percentile": 0.9, "90th_percentile": 0.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 0.9, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.9, "10th_percentile": 0.9, "90th_percentile": 0.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 0.9, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.9, "10th_percentile": 0.9, "90th_percentile": 0.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.47, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% 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 OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1.16, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1.16, "10th_percentile": 1.16, "90th_percentile": 1.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1.4, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% 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 Outpatient Services; 70% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 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 (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC 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": "NMHC 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": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC 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": "HEALTHLINK [125]", "plan_name": "NMHC 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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC 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" } ] } ] }, { "description": "ACETAMINOPHEN 500 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-102", "type": "CDM" }, { "code": "CHRG1625", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "57896-0222-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.54, "maximum": 2.0, "setting": "outpatient", "gross_charge": 2.0, "discounted_cash": 1.4, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 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 (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC 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": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC 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": "HEALTHLINK [125]", "plan_name": "NMHC 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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC 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" } ] } ] }, { "description": "ACETAMINOPHEN 500 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-102", "type": "CDM" }, { "code": "CHRG1625", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "71399-8022-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.54, "maximum": 2.0, "setting": "outpatient", "gross_charge": 2.0, "discounted_cash": 1.4, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 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 (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC 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": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC 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": "HEALTHLINK [125]", "plan_name": "NMHC 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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC 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" } ] } ] }, { "description": "ACETAMINOPHEN 500 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-102", "type": "CDM" }, { "code": "CHRG1625", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "71399-8027-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.54, "maximum": 2.0, "setting": "outpatient", "gross_charge": 2.0, "discounted_cash": 1.4, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 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 (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC 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": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC 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": "HEALTHLINK [125]", "plan_name": "NMHC 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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC 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" } ] } ] }, { "description": "ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN", "drug_information": { "unit": 65.0, "type": "ML" }, "code_information": [ { "code": "RX-186132", "type": "CDM" }, { "code": "J0131", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "24201-0100-24", "type": "NDC" } ], "standard_charges": [ { "minimum": 4.12, "maximum": 258.25, "setting": "outpatient", "gross_charge": 21.25, "discounted_cash": 14.87, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 21.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 162.25, "10th_percentile": 49.45, "90th_percentile": 239.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 258.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 162.25, "10th_percentile": 49.45, "90th_percentile": 239.05, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 258.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 210.25, "10th_percentile": 171.85, "90th_percentile": 248.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 21.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 21.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 162.25, "10th_percentile": 49.45, "90th_percentile": 239.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 258.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 162.25, "10th_percentile": 49.45, "90th_percentile": 239.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 21.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 162.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 162.25, "10th_percentile": 49.45, "90th_percentile": 239.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 162.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 210.25, "10th_percentile": 171.85, "90th_percentile": 248.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 162.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 162.25, "10th_percentile": 49.45, "90th_percentile": 239.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 162.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 162.25, "10th_percentile": 49.45, "90th_percentile": 239.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 162.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 162.25, "10th_percentile": 49.45, "90th_percentile": 239.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 162.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 162.25, "10th_percentile": 49.45, "90th_percentile": 239.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 21.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 162.25, "10th_percentile": 49.45, "90th_percentile": 239.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 162.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 162.25, "10th_percentile": 49.45, "90th_percentile": 239.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 258.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 162.25, "10th_percentile": 49.45, "90th_percentile": 239.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 73.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 94.61, "10th_percentile": 77.33, "90th_percentile": 111.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 116.21, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 94.61, "10th_percentile": 77.33, "90th_percentile": 111.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 116.21, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 94.61, "10th_percentile": 77.33, "90th_percentile": 111.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 73.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 94.61, "10th_percentile": 77.33, "90th_percentile": 111.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 9.56, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 73.01, "10th_percentile": 22.25, "90th_percentile": 107.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 73.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 73.01, "10th_percentile": 22.25, "90th_percentile": 107.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 116.21, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 73.01, "10th_percentile": 22.25, "90th_percentile": 107.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 5.74, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 43.81, "10th_percentile": 13.35, "90th_percentile": 64.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 43.81, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 43.81, "10th_percentile": 13.35, "90th_percentile": 64.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 69.73, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 43.81, "10th_percentile": 13.35, "90th_percentile": 64.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 43.81, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 56.77, "10th_percentile": 46.4, "90th_percentile": 67.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 69.73, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 56.77, "10th_percentile": 46.4, "90th_percentile": 67.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 81.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 105.13, "10th_percentile": 85.93, "90th_percentile": 124.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 129.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 105.13, "10th_percentile": 85.93, "90th_percentile": 124.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 129.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 81.13, "10th_percentile": 24.73, "90th_percentile": 119.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 81.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 81.13, "10th_percentile": 24.73, "90th_percentile": 119.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 10.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 81.13, "10th_percentile": 24.73, "90th_percentile": 119.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 37.97, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 49.2, "10th_percentile": 40.22, "90th_percentile": 58.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 60.43, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 49.2, "10th_percentile": 40.22, "90th_percentile": 58.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 113.58, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 147.18, "10th_percentile": 120.3, "90th_percentile": 174.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 180.78, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 147.18, "10th_percentile": 120.3, "90th_percentile": 174.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 94.11, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 121.95, "10th_percentile": 99.68, "90th_percentile": 144.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 149.79, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 121.95, "10th_percentile": 99.68, "90th_percentile": 144.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 21.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 21.25, "10th_percentile": 21.25, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 18.06, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 18.06, "10th_percentile": 18.06, "90th_percentile": 18.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 17.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 17.0, "10th_percentile": 17.0, "90th_percentile": 17.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 17.43, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 17.43, "10th_percentile": 17.43, "90th_percentile": 17.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 13.81, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 13.81, "10th_percentile": 13.81, "90th_percentile": 13.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 6.38, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 6.38, "10th_percentile": 6.38, "90th_percentile": 6.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 17.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 17.0, "10th_percentile": 17.0, "90th_percentile": 17.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 10.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 10.63, "10th_percentile": 10.63, "90th_percentile": 10.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 4.12, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 4.12, "10th_percentile": 4.12, "90th_percentile": 4.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 7.5, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "Drugs/Agents ; 35.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "Drugs/Agents ; 35.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 21.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $21.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 21.25, "10th_percentile": 21.25, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $21.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 21.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 21.25, "10th_percentile": 21.25, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 8.5, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 8.5, "10th_percentile": 8.5, "90th_percentile": 8.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 8.5, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 8.5, "10th_percentile": 8.5, "90th_percentile": 8.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 21.25, "10th_percentile": 21.25, "90th_percentile": 21.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 21.25, "10th_percentile": 21.25, "90th_percentile": 21.25, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 21.25, "10th_percentile": 21.25, "90th_percentile": 21.25, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" } ] } ] }, { "description": "ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLN", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "RX-181464", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "81033-0002-05", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.53, "maximum": 2.25, "setting": "outpatient", "gross_charge": 2.25, "discounted_cash": 1.57, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 1.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.01, "10th_percentile": 1.01, "90th_percentile": 1.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.01, "10th_percentile": 1.01, "90th_percentile": 1.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.01, "10th_percentile": 1.01, "90th_percentile": 1.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.61, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": 0.66, "90th_percentile": 1.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.15, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": 0.66, "90th_percentile": 1.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.15, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": 0.66, "90th_percentile": 1.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.61, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": 0.66, "90th_percentile": 1.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1.13, "10th_percentile": 1.13, "90th_percentile": 1.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1.13, "10th_percentile": 1.13, "90th_percentile": 1.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.53, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 0.76, "10th_percentile": 0.58, "90th_percentile": 0.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.99, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 0.76, "10th_percentile": 0.58, "90th_percentile": 0.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1.58, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1.58, "10th_percentile": 1.58, "90th_percentile": 1.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1.31, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1.31, "10th_percentile": 1.31, "90th_percentile": 1.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" } ] } ] }, { "description": "ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLN", "drug_information": { "unit": 10.15, "type": "ML" }, "code_information": [ { "code": "RX-181465", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00121-1314-00", "type": "NDC" } ], "standard_charges": [ { "minimum": 4.1, "maximum": 17.5, "setting": "outpatient", "gross_charge": 17.5, "discounted_cash": 12.25, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC 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": "HEALTHLINK [125]", "plan_name": "NMHC 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": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC 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": "UNITED HEALTHCARE [158]", "plan_name": "NMHC 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": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC 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": "NMHC 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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC 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": "NMHC 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": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 17.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 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 (Non-Contracted); 100% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 10.15, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 10.15, "10th_percentile": 10.15, "90th_percentile": 10.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 12.25, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 12.25, "10th_percentile": 12.25, "90th_percentile": 12.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 4.1, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 4.1, "10th_percentile": 4.1, "90th_percentile": 4.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 8.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 8.75, "10th_percentile": 8.75, "90th_percentile": 8.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 8.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 8.75, "10th_percentile": 8.75, "90th_percentile": 8.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 4.73, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.73, "10th_percentile": 4.73, "90th_percentile": 4.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 4.73, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.73, "10th_percentile": 4.73, "90th_percentile": 4.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 7.88, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.88, "10th_percentile": 7.88, "90th_percentile": 7.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 7.88, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.88, "10th_percentile": 7.88, "90th_percentile": 7.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 7.88, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.88, "10th_percentile": 7.88, "90th_percentile": 7.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLN", "drug_information": { "unit": 10.15, "type": "ML" }, "code_information": [ { "code": "RX-181465", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "39328-0032-50", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.53, "maximum": 2.25, "setting": "outpatient", "gross_charge": 2.25, "discounted_cash": 1.57, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 1.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.01, "10th_percentile": 1.01, "90th_percentile": 1.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 1.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.01, "10th_percentile": 1.01, "90th_percentile": 1.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.01, "10th_percentile": 1.01, "90th_percentile": 1.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.01, "10th_percentile": 1.01, "90th_percentile": 1.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.01, "10th_percentile": 1.01, "90th_percentile": 1.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.01, "10th_percentile": 1.01, "90th_percentile": 1.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1.13, "10th_percentile": 1.13, "90th_percentile": 1.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1.13, "10th_percentile": 1.13, "90th_percentile": 1.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1.13, "10th_percentile": 1.13, "90th_percentile": 1.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1.13, "10th_percentile": 1.13, "90th_percentile": 1.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.61, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.61, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.61, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.61, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.53, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 0.53, "10th_percentile": 0.53, "90th_percentile": 0.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.53, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 0.53, "10th_percentile": 0.53, "90th_percentile": 0.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1.31, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1.31, "10th_percentile": 1.31, "90th_percentile": 1.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1.31, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1.31, "10th_percentile": 1.31, "90th_percentile": 1.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1.58, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1.58, "10th_percentile": 1.58, "90th_percentile": 1.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1.58, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1.58, "10th_percentile": 1.58, "90th_percentile": 1.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" } ] } ] }, { "description": "ACETAMINOPHEN-CAFFEINE 500-65 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-84336", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "00067-2045-91", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.47, "maximum": 2.0, "setting": "outpatient", "gross_charge": 2.0, "discounted_cash": 1.4, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 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 (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 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 (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC 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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC 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": "NMHC 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": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC 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": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC 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": "HEALTHLINK [125]", "plan_name": "NMHC 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": "HEALTHLINK [125]", "plan_name": "NMHC 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": "NMHC 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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC 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": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.47, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% 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 OP Services; 23.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 0.9, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.9, "10th_percentile": 0.9, "90th_percentile": 0.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 0.9, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.9, "10th_percentile": 0.9, "90th_percentile": 0.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 0.9, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.9, "10th_percentile": 0.9, "90th_percentile": 0.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1.16, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1.16, "10th_percentile": 1.16, "90th_percentile": 1.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1.4, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% 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 Outpatient Services; 70% Billed" } ] } ] }, { "description": "ACETAZOLAMIDE 125 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-112", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "51672-4022-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.19, "maximum": 6.75, "setting": "outpatient", "gross_charge": 1.0, "discounted_cash": 0.7, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 1.2, "90th_percentile": 5.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 1.2, "90th_percentile": 5.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 1.2, "90th_percentile": 5.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 1.2, "90th_percentile": 5.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 1.2, "90th_percentile": 5.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 1.2, "90th_percentile": 5.8, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4.38, "10th_percentile": 2.48, "90th_percentile": 6.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4.38, "10th_percentile": 2.48, "90th_percentile": 6.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 1.2, "90th_percentile": 5.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 1.2, "90th_percentile": 5.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 1.2, "90th_percentile": 5.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 1.2, "90th_percentile": 5.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 1.2, "90th_percentile": 5.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 1.2, "90th_percentile": 5.8, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4.38, "10th_percentile": 2.48, "90th_percentile": 6.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4.38, "10th_percentile": 2.48, "90th_percentile": 6.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC 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": 1.2, "90th_percentile": 5.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC 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": 1.2, "90th_percentile": 5.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC 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": 1.2, "90th_percentile": 5.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC 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": 1.2, "90th_percentile": 5.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC 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": 1.2, "90th_percentile": 5.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC 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": 1.2, "90th_percentile": 5.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.27, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.32, "90th_percentile": 1.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 0.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1.0, "10th_percentile": 0.6, "90th_percentile": 2.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 0.45, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.9, "10th_percentile": 0.54, "90th_percentile": 2.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 2.0, "10th_percentile": 1.2, "90th_percentile": 5.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1.00 so that total pmt for all claim lines does not exceed 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 Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 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 - OON; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 0.35, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 0.35, "10th_percentile": 0.35, "90th_percentile": 0.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 0.85, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 0.85, "10th_percentile": 0.85, "90th_percentile": 0.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 0.3, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 0.3, "10th_percentile": 0.3, "90th_percentile": 0.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 0.82, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% 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 Procedures; 82% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.19, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 0.19, "10th_percentile": 0.19, "90th_percentile": 0.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 0.23, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.23, "10th_percentile": 0.23, "90th_percentile": 0.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 0.32, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.32, "10th_percentile": 0.32, "90th_percentile": 0.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 0.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 0.4, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 0.4, "10th_percentile": 0.4, "90th_percentile": 0.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 0.4, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 0.4, "10th_percentile": 0.4, "90th_percentile": 0.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 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 OP; 80% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 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": "Remaining Charges; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 0.65, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 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": "All Procedures; 65% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.82, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.32, "90th_percentile": 1.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.32, "90th_percentile": 1.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.82, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.18, "10th_percentile": 0.67, "90th_percentile": 1.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.18, "10th_percentile": 0.67, "90th_percentile": 1.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3.04, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.9, "10th_percentile": 0.54, "90th_percentile": 2.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 0.9, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.9, "10th_percentile": 0.54, "90th_percentile": 2.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 0.9, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.97, "10th_percentile": 1.11, "90th_percentile": 2.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3.04, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.97, "10th_percentile": 1.11, "90th_percentile": 2.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2.19, "10th_percentile": 1.24, "90th_percentile": 3.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2.19, "10th_percentile": 1.24, "90th_percentile": 3.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1.0, "10th_percentile": 0.6, "90th_percentile": 2.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1.0, "10th_percentile": 0.6, "90th_percentile": 2.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1.58, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1.02, "10th_percentile": 0.58, "90th_percentile": 1.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.47, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1.02, "10th_percentile": 0.58, "90th_percentile": 1.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 0.9, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.97, "10th_percentile": 1.11, "90th_percentile": 2.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 3.04, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.97, "10th_percentile": 1.11, "90th_percentile": 2.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1.4, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 3.07, "10th_percentile": 1.73, "90th_percentile": 4.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 4.73, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 3.07, "10th_percentile": 1.73, "90th_percentile": 4.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 3.92, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 2.54, "10th_percentile": 1.44, "90th_percentile": 3.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1.16, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 2.54, "10th_percentile": 1.44, "90th_percentile": 3.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 2.0, "10th_percentile": 1.2, "90th_percentile": 5.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 6.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 2.0, "10th_percentile": 1.2, "90th_percentile": 5.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "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": "NMH AETNA TRANSPLANT", "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": "NMH IL HEALTH PARTNERS IPA", "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": "MULTIPLAN/PHCS [142]", "plan_name": "NMH 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": "ACETAZOLAMIDE 125 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-112", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "70756-0720-11", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.47, "maximum": 13.5, "setting": "outpatient", "gross_charge": 13.5, "discounted_cash": 9.45, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.5, "10th_percentile": 13.5, "90th_percentile": 13.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.5, "10th_percentile": 13.5, "90th_percentile": 13.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.5, "10th_percentile": 13.5, "90th_percentile": 13.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.5, "10th_percentile": 13.5, "90th_percentile": 13.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.5, "10th_percentile": 13.5, "90th_percentile": 13.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.5, "10th_percentile": 13.5, "90th_percentile": 13.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.5, "10th_percentile": 13.5, "90th_percentile": 13.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.5, "10th_percentile": 13.5, "90th_percentile": 13.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.09, "10th_percentile": 0.85, "90th_percentile": 3.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.09, "10th_percentile": 0.85, "90th_percentile": 3.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3.65, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.09, "10th_percentile": 0.85, "90th_percentile": 3.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3.65, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.09, "10th_percentile": 0.85, "90th_percentile": 3.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 6.08, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 6.08, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 6.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% 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 Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 6.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% 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 Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 3.16, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1.81, "10th_percentile": 0.74, "90th_percentile": 2.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.47, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1.81, "10th_percentile": 0.74, "90th_percentile": 2.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 6.08, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 9.45, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 9.45, "10th_percentile": 9.45, "90th_percentile": 9.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 7.83, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 7.83, "10th_percentile": 7.83, "90th_percentile": 7.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 13.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 13.5, "10th_percentile": 13.5, "90th_percentile": 13.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" } ] } ] }, { "description": "ACETAZOLAMIDE 250 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-113", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "70756-0721-11", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.47, "maximum": 14.5, "setting": "outpatient", "gross_charge": 14.5, "discounted_cash": 10.15, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC 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": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "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": "NMHC 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": 3.6, "90th_percentile": 14.0, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC 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": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC 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": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC 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": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "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": "NMHC 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": 3.6, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "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": "NMHC 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": 3.6, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.88, "10th_percentile": 7.95, "90th_percentile": 14.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.88, "10th_percentile": 7.95, "90th_percentile": 14.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 12.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.88, "10th_percentile": 7.95, "90th_percentile": 14.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.88, "10th_percentile": 7.95, "90th_percentile": 14.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.97, "90th_percentile": 3.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.62, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.97, "90th_percentile": 3.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3.92, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.97, "90th_percentile": 3.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3.38, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.97, "90th_percentile": 3.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3.58, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.97, "90th_percentile": 3.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3.92, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": 0.54, "90th_percentile": 3.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3.58, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": 0.54, "90th_percentile": 3.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3.38, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": 0.54, "90th_percentile": 3.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.62, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": 0.54, "90th_percentile": 3.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": 0.54, "90th_percentile": 3.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": 0.54, "90th_percentile": 3.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 5.63, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.79, "10th_percentile": 3.58, "90th_percentile": 6.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 5.96, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.79, "10th_percentile": 3.58, "90th_percentile": 6.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 6.53, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.79, "10th_percentile": 3.58, "90th_percentile": 6.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2.7, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.79, "10th_percentile": 3.58, "90th_percentile": 6.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 5.96, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.79, "10th_percentile": 3.58, "90th_percentile": 6.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 5.63, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.79, "10th_percentile": 3.58, "90th_percentile": 6.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 6.53, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.79, "10th_percentile": 3.58, "90th_percentile": 6.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2.7, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.79, "10th_percentile": 3.58, "90th_percentile": 6.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 7.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 6.44, "10th_percentile": 3.97, "90th_percentile": 7.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 6.44, "10th_percentile": 3.97, "90th_percentile": 7.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 6.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 6.44, "10th_percentile": 3.97, "90th_percentile": 7.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 6.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 6.44, "10th_percentile": 3.97, "90th_percentile": 7.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 6.44, "10th_percentile": 3.97, "90th_percentile": 7.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 7.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 6.44, "10th_percentile": 3.97, "90th_percentile": 7.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 6.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 6.44, "10th_percentile": 3.97, "90th_percentile": 7.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 6.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 6.44, "10th_percentile": 3.97, "90th_percentile": 7.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 3.1, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 2.93, "10th_percentile": 0.84, "90th_percentile": 3.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 2.93, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 2.93, "10th_percentile": 0.84, "90th_percentile": 3.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 3.39, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 2.93, "10th_percentile": 0.84, "90th_percentile": 3.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1.4, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 2.93, "10th_percentile": 0.84, "90th_percentile": 3.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.47, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 2.93, "10th_percentile": 0.84, "90th_percentile": 3.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 2.7, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.79, "10th_percentile": 3.58, "90th_percentile": 6.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 6.53, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.79, "10th_percentile": 3.58, "90th_percentile": 6.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 5.63, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.79, "10th_percentile": 3.58, "90th_percentile": 6.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 5.96, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.79, "10th_percentile": 3.58, "90th_percentile": 6.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 4.2, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 9.02, "10th_percentile": 5.57, "90th_percentile": 9.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 10.15, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 9.02, "10th_percentile": 5.57, "90th_percentile": 9.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 8.75, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 9.02, "10th_percentile": 5.57, "90th_percentile": 9.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 9.28, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 9.02, "10th_percentile": 5.57, "90th_percentile": 9.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 3.48, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 7.47, "10th_percentile": 4.61, "90th_percentile": 8.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 8.41, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 7.47, "10th_percentile": 4.61, "90th_percentile": 8.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 7.25, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 7.47, "10th_percentile": 4.61, "90th_percentile": 8.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 7.69, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 7.47, "10th_percentile": 4.61, "90th_percentile": 8.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 6.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 14.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 12.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 13.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 12.5, "10th_percentile": 3.6, "90th_percentile": 14.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" } ] } ] }, { "description": "ACETIC ACID 0.25 % IRR SOLN", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "RX-8963", "type": "CDM" }, { "code": "27200000", "type": "LOCAL" }, { "code": "0272", "type": "RC" }, { "code": "00990-6143-09", "type": "NDC" } ], "standard_charges": [ { "minimum": 62.3, "maximum": 266.25, "setting": "outpatient", "gross_charge": 266.25, "discounted_cash": 186.37, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 266.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 266.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 266.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 266.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 266.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 266.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 266.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 266.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 266.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 71.89, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 71.89, "10th_percentile": 71.89, "90th_percentile": 71.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 119.81, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 119.81, "10th_percentile": 119.81, "90th_percentile": 119.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 119.81, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 119.81, "10th_percentile": 119.81, "90th_percentile": 119.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 133.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 133.13, "10th_percentile": 133.13, "90th_percentile": 133.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 62.3, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 62.3, "10th_percentile": 62.3, "90th_percentile": 62.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 154.43, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 154.43, "10th_percentile": 154.43, "90th_percentile": 154.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 119.81, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 119.81, "10th_percentile": 119.81, "90th_percentile": 119.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 133.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 133.13, "10th_percentile": 133.13, "90th_percentile": 133.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 71.89, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 71.89, "10th_percentile": 71.89, "90th_percentile": 71.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 186.38, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 186.38, "10th_percentile": 186.38, "90th_percentile": 186.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" } ] } ] }, { "description": "ACETIC ACID (BULK) 3 % MISC LIQD", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "RX-172862", "type": "CDM" }, { "code": "25000000", "type": "LOCAL" }, { "code": "0250", "type": "RC" }, { "code": "51552-0051-06", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.42, "maximum": 39.5, "setting": "outpatient", "gross_charge": 39.5, "discounted_cash": 27.65, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 39.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.88, "10th_percentile": 9.58, "90th_percentile": 36.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.88, "10th_percentile": 9.58, "90th_percentile": 36.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 39.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 39.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 39.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 39.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 39.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 39.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 39.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 5.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 6.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 39.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 6.25, "10th_percentile": 5.45, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 2.81, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.29, "10th_percentile": 4.31, "90th_percentile": 16.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 17.78, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.29, "10th_percentile": 4.31, "90th_percentile": 16.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2.81, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.29, "10th_percentile": 4.31, "90th_percentile": 16.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 17.78, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.29, "10th_percentile": 4.31, "90th_percentile": 16.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 17.78, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.29, "10th_percentile": 4.31, "90th_percentile": 16.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2.81, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.29, "10th_percentile": 4.31, "90th_percentile": 16.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 10.67, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.18, "10th_percentile": 2.59, "90th_percentile": 9.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.69, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.18, "10th_percentile": 2.59, "90th_percentile": 9.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.42, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.69, "10th_percentile": 1.47, "90th_percentile": 8.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.69, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.69, "10th_percentile": 1.47, "90th_percentile": 8.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 10.67, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.69, "10th_percentile": 1.47, "90th_percentile": 8.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 19.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 11.44, "10th_percentile": 4.79, "90th_percentile": 18.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 11.44, "10th_percentile": 4.79, "90th_percentile": 18.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 11.44, "10th_percentile": 4.79, "90th_percentile": 18.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 19.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 11.44, "10th_percentile": 4.79, "90th_percentile": 18.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1.46, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 5.35, "10th_percentile": 2.24, "90th_percentile": 8.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 9.24, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 5.35, "10th_percentile": 2.24, "90th_percentile": 8.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 27.65, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 16.02, "10th_percentile": 6.71, "90th_percentile": 25.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 4.38, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 16.02, "10th_percentile": 6.71, "90th_percentile": 25.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 3.63, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 13.27, "10th_percentile": 5.56, "90th_percentile": 20.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 22.91, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 13.27, "10th_percentile": 5.56, "90th_percentile": 20.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" } ] } ] }, { "description": "ACETYLCHOLINE CHLORIDE 20 MCG/ML SDVL 10 ML (CATH LAB ONLY)", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "RX-408657", "type": "CDM" }, { "code": "25000000", "type": "LOCAL" }, { "code": "0250", "type": "RC" }, { "code": "99991-0018-58", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.19, "maximum": 1.0, "setting": "outpatient", "gross_charge": 1.0, "discounted_cash": 0.7, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC 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": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC 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": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC 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": "HEALTHLINK [125]", "plan_name": "NMHC 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": "NMHC 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": "NMHC 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": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 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 (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.27, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.27, "10th_percentile": 0.27, "90th_percentile": 0.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 0.45, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.45, "10th_percentile": 0.45, "90th_percentile": 0.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 0.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH 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": "NMH AETNA ASA", "standard_charge_dollar": 0.35, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 0.35, "10th_percentile": 0.35, "90th_percentile": 0.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 0.4, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 0.4, "10th_percentile": 0.4, "90th_percentile": 0.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 0.4, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 0.4, "10th_percentile": 0.4, "90th_percentile": 0.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 0.65, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.65, "10th_percentile": 0.65, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 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": "Remaining Charges; 80% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 0.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 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": "All Procedures; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 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 OP; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.19, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 0.19, "10th_percentile": 0.19, "90th_percentile": 0.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 0.82, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% 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 Procedures; 82% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 0.23, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.23, "10th_percentile": 0.23, "90th_percentile": 0.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 0.3, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 0.3, "10th_percentile": 0.3, "90th_percentile": 0.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 0.85, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 0.85, "10th_percentile": 0.85, "90th_percentile": 0.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 0.32, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.32, "10th_percentile": 0.32, "90th_percentile": 0.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 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 - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1.00 so that total pmt for all claim lines does not exceed 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 Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "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": "NMH AETNA TRANSPLANT", "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": "NMH IL HEALTH PARTNERS IPA", "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": "ACETYLCYSTEINE 100 MG/ML (10 %) MISC SOLN", "drug_information": { "unit": 6.0, "type": "ML" }, "code_information": [ { "code": "RX-122", "type": "CDM" }, { "code": "25000000", "type": "LOCAL" }, { "code": "0250", "type": "RC" }, { "code": "70069-0018-25", "type": "NDC" } ], "standard_charges": [ { "minimum": 9.7, "maximum": 50.0, "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 35.0, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 50.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 50.0, "10th_percentile": 50.0, "90th_percentile": 50.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 50.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 50.0, "10th_percentile": 50.0, "90th_percentile": 50.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 50.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 50.0, "10th_percentile": 50.0, "90th_percentile": 50.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 50.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 50.0, "10th_percentile": 50.0, "90th_percentile": 50.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 50.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 50.0, "10th_percentile": 50.0, "90th_percentile": 50.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 50.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 50.0, "10th_percentile": 50.0, "90th_percentile": 50.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 50.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 50.0, "10th_percentile": 50.0, "90th_percentile": 50.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 17.65, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 17.65, "10th_percentile": 17.65, "90th_percentile": 17.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 20.0, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% 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 Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 20.0, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% 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 Services; 40% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 32.4, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 32.4, "10th_percentile": 32.4, "90th_percentile": 32.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 29.15, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.15, "10th_percentile": 29.15, "90th_percentile": 29.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 40.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 29.05, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.05, "10th_percentile": 29.05, "90th_percentile": 29.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 25.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 25.0, "10th_percentile": 25.0, "90th_percentile": 25.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 32.5, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% 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 Procedures; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 40.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% 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 Other OP; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 9.7, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 9.7, "10th_percentile": 9.7, "90th_percentile": 9.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 41.0, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 41.0, "10th_percentile": 41.0, "90th_percentile": 41.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 11.65, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.65, "10th_percentile": 11.65, "90th_percentile": 11.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 15.0, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% 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 OP Services; 30% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 42.5, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 42.5, "10th_percentile": 42.5, "90th_percentile": 42.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 16.0, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 16.0, "10th_percentile": 16.0, "90th_percentile": 16.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 50.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 50.0, "10th_percentile": 50.0, "90th_percentile": 50.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 50.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $50.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 50.0, "10th_percentile": 50.0, "90th_percentile": 50.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $50.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 50.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 50.0, "10th_percentile": 50.0, "90th_percentile": 50.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 13.5, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.5, "10th_percentile": 13.5, "90th_percentile": 13.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 25.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% 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 Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 22.5, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 22.5, "10th_percentile": 22.5, "90th_percentile": 22.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 50.0, "10th_percentile": 50.0, "90th_percentile": 50.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 50.0, "10th_percentile": 50.0, "90th_percentile": 50.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 50.0, "10th_percentile": 50.0, "90th_percentile": 50.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ACETYLCYSTEINE 200 MG/ML (20 %) IV SOLN", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "RX-97031", "type": "CDM" }, { "code": "J0132", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "63323-0963-44", "type": "NDC" } ], "standard_charges": [ { "minimum": 3.57, "maximum": 62.25, "setting": "outpatient", "gross_charge": 62.25, "discounted_cash": 43.57, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 62.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 62.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 62.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 62.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 41.75, "10th_percentile": 31.55, "90th_percentile": 58.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 62.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 62.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 62.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 62.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 41.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 41.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 41.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 41.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 41.75, "10th_percentile": 31.55, "90th_percentile": 58.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 41.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 41.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 41.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 41.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 29.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 29.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 29.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 29.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 41.75, "10th_percentile": 31.55, "90th_percentile": 58.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 29.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 29.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 29.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 29.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 62.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 41.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 29.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 17.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 35.38, "10th_percentile": 20.95, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 28.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.79, "10th_percentile": 14.2, "90th_percentile": 26.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 18.79, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.79, "10th_percentile": 14.2, "90th_percentile": 26.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 13.05, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.79, "10th_percentile": 14.2, "90th_percentile": 26.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 13.05, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.79, "10th_percentile": 14.2, "90th_percentile": 26.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 18.79, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.79, "10th_percentile": 14.2, "90th_percentile": 26.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 28.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.79, "10th_percentile": 14.2, "90th_percentile": 26.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 28.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.79, "10th_percentile": 14.2, "90th_percentile": 26.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 18.79, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.79, "10th_percentile": 14.2, "90th_percentile": 26.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 13.05, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.79, "10th_percentile": 14.2, "90th_percentile": 26.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 16.81, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.83, "10th_percentile": 4.36, "90th_percentile": 14.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 11.27, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.83, "10th_percentile": 4.36, "90th_percentile": 14.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 7.83, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.83, "10th_percentile": 4.36, "90th_percentile": 14.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 4.73, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.83, "10th_percentile": 4.36, "90th_percentile": 14.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 4.12, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.83, "10th_percentile": 4.36, "90th_percentile": 14.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 16.81, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.55, "10th_percentile": 5.23, "90th_percentile": 15.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 11.27, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.55, "10th_percentile": 5.23, "90th_percentile": 15.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 7.83, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.55, "10th_percentile": 5.23, "90th_percentile": 15.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 4.12, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.55, "10th_percentile": 5.23, "90th_percentile": 15.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 31.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 20.88, "10th_percentile": 15.78, "90th_percentile": 29.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 20.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 20.88, "10th_percentile": 15.78, "90th_percentile": 29.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 14.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 20.88, "10th_percentile": 15.78, "90th_percentile": 29.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 14.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 20.88, "10th_percentile": 15.78, "90th_percentile": 29.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 20.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 20.88, "10th_percentile": 15.78, "90th_percentile": 29.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 31.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 20.88, "10th_percentile": 15.78, "90th_percentile": 29.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 3.57, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 8.28, "10th_percentile": 4.54, "90th_percentile": 13.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 6.79, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 8.28, "10th_percentile": 4.54, "90th_percentile": 13.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 9.77, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 8.28, "10th_percentile": 4.54, "90th_percentile": 13.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 14.57, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 8.28, "10th_percentile": 4.54, "90th_percentile": 13.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 20.3, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 29.23, "10th_percentile": 22.09, "90th_percentile": 40.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 29.23, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 29.23, "10th_percentile": 22.09, "90th_percentile": 40.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 43.58, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 29.23, "10th_percentile": 22.09, "90th_percentile": 40.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 16.82, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 24.22, "10th_percentile": 18.3, "90th_percentile": 33.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 24.22, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 24.22, "10th_percentile": 18.3, "90th_percentile": 33.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 36.11, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 24.22, "10th_percentile": 18.3, "90th_percentile": 33.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" } ] } ] }, { "description": "ACETYLCYSTEINE 200 MG/ML (20 %) IV SOLN", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "RX-97031", "type": "CDM" }, { "code": "J0132", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "70594-0111-02", "type": "NDC" } ], "standard_charges": [ { "minimum": 2.98, "maximum": 14.5, "setting": "outpatient", "gross_charge": 14.5, "discounted_cash": 10.15, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14.5, "10th_percentile": 14.5, "90th_percentile": 14.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14.5, "10th_percentile": 14.5, "90th_percentile": 14.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14.5, "10th_percentile": 14.5, "90th_percentile": 14.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14.5, "10th_percentile": 14.5, "90th_percentile": 14.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14.5, "10th_percentile": 14.5, "90th_percentile": 14.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14.5, "10th_percentile": 14.5, "90th_percentile": 14.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14.5, "10th_percentile": 14.5, "90th_percentile": 14.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 14.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 14.5, "10th_percentile": 14.5, "90th_percentile": 14.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3.44, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.68, "10th_percentile": 3.49, "90th_percentile": 3.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3.92, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.68, "10th_percentile": 3.49, "90th_percentile": 3.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3.44, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.44, "10th_percentile": 3.44, "90th_percentile": 3.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 2.98, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 2.98, "10th_percentile": 2.98, "90th_percentile": 2.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" } ] } ] }, { "description": "ACETYLCYSTEINE 600 MG ORAL CAP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-101117", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "54629-4097-60", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.47, "maximum": 0.54, "setting": "outpatient", "gross_charge": 2.0, "discounted_cash": 1.4, "payers_information": [ { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.47, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% 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 OP Services; 23.4% Billed" } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "gross_charge": 37850.74, "discounted_cash": 26495.52, "payers_information": [ { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 37850.75, "10th_percentile": 37850.75, "90th_percentile": 37850.75, "count": "114", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.816255465; Using historical claim(s); Scope: All Financial Classes; Cases: 114; All IP Services - OON; 100% Billed", "median_amount": 37850.75, "10th_percentile": 37850.75, "90th_percentile": 37850.75, "count": "114", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.816255465; Using historical claim(s); Scope: All Financial Classes; Cases: 114; All IP Services; 100% Billed", "median_amount": 37850.75, "10th_percentile": 37850.75, "90th_percentile": 37850.75, "count": "114", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.665392848; Using historical claim(s); Scope: All Financial Classes; Cases: 16; All IP Services (Non-Contracted); 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.838745992; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services (Non-Contracted); 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.749937033; Using historical claim(s); Scope: All Financial Classes; Cases: 17; All IP Services (Non-Contracted); 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.769698814; Using historical claim(s); Scope: All Financial Classes; Cases: 8; All IP Services (Non-Contracted); 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.831171916; Using historical claim(s); Scope: All Financial Classes; Cases: 47; All IP Services (Non-Contracted); 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.816255465; Using historical claim(s); Scope: All Financial Classes; Cases: 114; All IP Services (Non-Contracted); 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.831171916; Using historical claim(s); Scope: All Financial Classes; Cases: 47; All IP Services; 100% Billed", "median_amount": 43050.0, "10th_percentile": 39273.57, "90th_percentile": 57274.98, "count": "81", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.769698814; Using historical claim(s); Scope: All Financial Classes; Cases: 8; All IP Services; 100% Billed", "median_amount": 43050.0, "10th_percentile": 39273.57, "90th_percentile": 57274.98, "count": "81", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.838745992; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 100% Billed", "median_amount": 43050.0, "10th_percentile": 39273.57, "90th_percentile": 57274.98, "count": "81", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.665392848; Using historical claim(s); Scope: All Financial Classes; Cases: 16; All IP Services; 100% Billed", "median_amount": 43050.0, "10th_percentile": 39273.57, "90th_percentile": 57274.98, "count": "81", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.665392848; Using historical claim(s); Scope: All Financial Classes; Cases: 16; All IP Services; 100% Billed", "median_amount": 40466.75, "10th_percentile": 39385.1, "90th_percentile": 55670.81, "count": "98", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.838745992; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 100% Billed", "median_amount": 40466.75, "10th_percentile": 39385.1, "90th_percentile": 55670.81, "count": "98", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.749937033; Using historical claim(s); Scope: All Financial Classes; Cases: 17; All IP Services; 100% Billed", "median_amount": 40466.75, "10th_percentile": 39385.1, "90th_percentile": 55670.81, "count": "98", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.769698814; Using historical claim(s); Scope: All Financial Classes; Cases: 8; All IP Services; 100% Billed", "median_amount": 40466.75, "10th_percentile": 39385.1, "90th_percentile": 55670.81, "count": "98", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.831171916; Using historical claim(s); Scope: All Financial Classes; Cases: 47; All IP Services; 100% Billed", "median_amount": 40466.75, "10th_percentile": 39385.1, "90th_percentile": 55670.81, "count": "98", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.665392848; Using historical claim(s); Scope: All Financial Classes; Cases: 16; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.838745992; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.749937033; Using historical claim(s); Scope: All Financial Classes; Cases: 17; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.769698814; Using historical claim(s); Scope: All Financial Classes; Cases: 8; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.831171916; Using historical claim(s); Scope: All Financial Classes; Cases: 47; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.816255465; Using historical claim(s); Scope: All Financial Classes; Cases: 114; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.665392848; Using historical claim(s); Scope: All Financial Classes; Cases: 16; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.838745992; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.749937033; Using historical claim(s); Scope: All Financial Classes; Cases: 17; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.769698814; Using historical claim(s); Scope: All Financial Classes; Cases: 8; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.831171916; Using historical claim(s); Scope: All Financial Classes; Cases: 47; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.816255465; Using historical claim(s); Scope: All Financial Classes; Cases: 114; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.816255465; Using historical claim(s); Scope: All Financial Classes; Cases: 114; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.831171916; Using historical claim(s); Scope: All Financial Classes; Cases: 47; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.769698814; Using historical claim(s); Scope: All Financial Classes; Cases: 8; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.749937033; Using historical claim(s); Scope: All Financial Classes; Cases: 17; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.838745992; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.665392848; Using historical claim(s); Scope: All Financial Classes; Cases: 16; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.665392848; Using historical claim(s); Scope: All Financial Classes; Cases: 16; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.838745992; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.749937033; Using historical claim(s); Scope: All Financial Classes; Cases: 17; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.769698814; Using historical claim(s); Scope: All Financial Classes; Cases: 8; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.831171916; Using historical claim(s); Scope: All Financial Classes; Cases: 47; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.816255465; Using historical claim(s); Scope: All Financial Classes; Cases: 114; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.665392848; Using historical claim(s); Scope: All Financial Classes; Cases: 16; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.838745992; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.749937033; Using historical claim(s); Scope: All Financial Classes; Cases: 17; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.769698814; Using historical claim(s); Scope: All Financial Classes; Cases: 8; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.831171916; Using historical claim(s); Scope: All Financial Classes; Cases: 47; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.816255465; Using historical claim(s); Scope: All Financial Classes; Cases: 114; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.816255465; Using historical claim(s); Scope: All Financial Classes; Cases: 114; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.831171916; Using historical claim(s); Scope: All Financial Classes; Cases: 47; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.769698814; Using historical claim(s); Scope: All Financial Classes; Cases: 8; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.749937033; Using historical claim(s); Scope: All Financial Classes; Cases: 17; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.838745992; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.665392848; Using historical claim(s); Scope: All Financial Classes; Cases: 16; All IP Services; 100% Billed", "median_amount": 40260.5, "10th_percentile": 38394.88, "90th_percentile": 54066.63, "count": "212", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_percentage": 30.0, "standard_charge_algorithm": "Re-evaluated: HLB.816255465; Using historical claim(s); Scope: All Financial Classes; Cases: 114; All IP Services; 30% Billed", "median_amount": 11355.23, "10th_percentile": 11355.23, "90th_percentile": 11355.23, "count": "114", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_percentage": 19.4, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 7343.06, "10th_percentile": 7343.06, "90th_percentile": 7343.06, "count": "114", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 24602.98, "10th_percentile": 24602.98, "90th_percentile": 24602.98, "count": "114", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_percentage": 85.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 32173.13, "10th_percentile": 32173.13, "90th_percentile": 32173.13, "count": "114", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 31037.63, "10th_percentile": 31037.63, "90th_percentile": 31037.63, "count": "114", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_percentage": 40.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 15140.29, "10th_percentile": 15140.29, "90th_percentile": 15140.29, "count": "114", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_percentage": 40.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 15140.29, "10th_percentile": 15140.29, "90th_percentile": 15140.29, "count": "114", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: HLB.831171916; Using historical claim(s); Scope: All Financial Classes; Cases: 47; All Inpatient Services; 70% Billed", "median_amount": 32232.03, "10th_percentile": 27569.57, "90th_percentile": 40139.06, "count": "83", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: HLB.769698814; Using historical claim(s); Scope: All Financial Classes; Cases: 8; All Inpatient Services; 70% Billed", "median_amount": 32232.03, "10th_percentile": 27569.57, "90th_percentile": 40139.06, "count": "83", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: HLB.838745992; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All Inpatient Services; 70% Billed", "median_amount": 32232.03, "10th_percentile": 27569.57, "90th_percentile": 40139.06, "count": "83", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: HLB.731336433; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All Inpatient Services; 70% Billed", "median_amount": 32232.03, "10th_percentile": 27569.57, "90th_percentile": 40139.06, "count": "83", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: HLB.665392848; Using historical claim(s); Scope: All Financial Classes; Cases: 16; All Inpatient Services; 70% Billed", "median_amount": 32232.03, "10th_percentile": 27569.57, "90th_percentile": 40139.06, "count": "83", "methodology": "percent of total billed charges" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Re-evaluated: HLB.831171916; Using historical claim(s); Scope: All Financial Classes; Cases: 47; All IP Services (Non-Contracted); 55% Billed", "median_amount": 25325.16, "10th_percentile": 21719.51, "90th_percentile": 31537.83, "count": "83", "methodology": "percent of total billed charges" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Re-evaluated: HLB.769698814; Using historical claim(s); Scope: All Financial Classes; Cases: 8; All IP Services (Non-Contracted); 55% Billed", "median_amount": 25325.16, "10th_percentile": 21719.51, "90th_percentile": 31537.83, "count": "83", "methodology": "percent of total billed charges" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Re-evaluated: HLB.838745992; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services (Non-Contracted); 55% Billed", "median_amount": 25325.16, "10th_percentile": 21719.51, "90th_percentile": 31537.83, "count": "83", "methodology": "percent of total billed charges" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Re-evaluated: HLB.731336433; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services (Non-Contracted); 55% Billed", "median_amount": 25325.16, "10th_percentile": 21719.51, 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"plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.731336433; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 39% Billed", "median_amount": 16572.03, "10th_percentile": 11923.4, "90th_percentile": 21900.46, "count": "135", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.838745992; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 39% Billed", "median_amount": 16572.03, "10th_percentile": 11923.4, "90th_percentile": 21900.46, "count": "135", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.831171916; Using historical claim(s); Scope: All 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"methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Re-evaluated: HLB.816255465; Using historical claim(s); Scope: All Financial Classes; Cases: 114; Inpatient Services; 50% Billed", "median_amount": 18925.38, "10th_percentile": 18925.38, "90th_percentile": 18925.38, "count": "114", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "median_amount": 21525.01, "10th_percentile": 19636.79, "90th_percentile": 28637.51, "count": "81", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional drugs, imaging 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"90th_percentile": 28637.51, "count": "81", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 20027.13, "10th_percentile": 19143.03, "90th_percentile": 27835.42, "count": "195", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 20027.13, "10th_percentile": 19143.03, "90th_percentile": 27835.42, "count": "195", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", 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"count": "12", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.769171326; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 38780.38, "10th_percentile": 29578.9, "90th_percentile": 48444.03, "count": "12", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.800498362; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services; 100% Billed", "median_amount": 38780.38, "10th_percentile": 29578.9, "90th_percentile": 48444.03, "count": "12", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.800498362; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services; 100% Billed", "median_amount": 38780.38, "10th_percentile": 29578.9, "90th_percentile": 48444.03, "count": "12", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.769171326; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 38780.38, "10th_percentile": 29578.9, "90th_percentile": 48444.03, "count": "12", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.786913007; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 38780.38, "10th_percentile": 29578.9, "90th_percentile": 48444.03, "count": "12", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.868004571; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 38780.38, "10th_percentile": 29578.9, "90th_percentile": 48444.03, "count": "12", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.786913007; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 29905.5, "10th_percentile": 29252.3, "90th_percentile": 30558.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.868004571; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 29905.5, "10th_percentile": 29252.3, "90th_percentile": 30558.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.769171326; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 30722.0, "10th_percentile": 29415.6, "90th_percentile": 43615.4, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.786913007; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 30722.0, "10th_percentile": 29415.6, "90th_percentile": 43615.4, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.868004571; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 30722.0, "10th_percentile": 29415.6, "90th_percentile": 43615.4, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 15361.01, "10th_percentile": 14707.81, "90th_percentile": 22725.01, "count": "11", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "median_amount": 15361.01, "10th_percentile": 14707.81, "90th_percentile": 22725.01, "count": "11", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "median_amount": 15361.01, "10th_percentile": 14707.81, "90th_percentile": 22725.01, "count": "11", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "median_amount": 13824.9, "10th_percentile": 13237.02, "90th_percentile": 20452.5, "count": "11", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "median_amount": 13824.9, "10th_percentile": 13237.02, "90th_percentile": 20452.5, "count": "11", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 13824.9, "10th_percentile": 13237.02, "90th_percentile": 20452.5, "count": "11", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_percentage": 19.4, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 9531.63, "10th_percentile": 9531.63, "90th_percentile": 9531.63, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 31935.8, "10th_percentile": 31935.8, "90th_percentile": 31935.8, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_percentage": 85.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 41762.2, "10th_percentile": 41762.2, "90th_percentile": 41762.2, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 40288.25, "10th_percentile": 40288.25, "90th_percentile": 40288.25, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_percentage": 40.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 19652.8, "10th_percentile": 19652.8, "90th_percentile": 19652.8, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_percentage": 40.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 19652.8, "10th_percentile": 19652.8, "90th_percentile": 19652.8, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_percentage": 30.0, "standard_charge_algorithm": "Re-evaluated: HLB.800498362; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services; 30% Billed", "median_amount": 14739.6, "10th_percentile": 14739.6, "90th_percentile": 14739.6, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.838025932; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 39% Billed", "median_amount": 11231.38, "10th_percentile": 9310.58, "90th_percentile": 11322.04, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.786913007; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 39% Billed", "median_amount": 11231.38, "10th_percentile": 9310.58, "90th_percentile": 11322.04, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.868004571; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 39% Billed", "median_amount": 11231.38, "10th_percentile": 9310.58, "90th_percentile": 11322.04, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: HLB.868004571; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All Inpatient Services; 70% Billed", "median_amount": 20933.85, "10th_percentile": 20476.61, "90th_percentile": 21391.09, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: HLB.786913007; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All Inpatient Services; 70% Billed", "median_amount": 20933.85, "10th_percentile": 20476.61, "90th_percentile": 21391.09, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Re-evaluated: HLB.868004571; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services (Non-Contracted); 55% Billed", "median_amount": 16520.16, "10th_percentile": 16103.19, "90th_percentile": 16937.13, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Re-evaluated: HLB.786913007; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services (Non-Contracted); 55% Billed", "median_amount": 16520.16, "10th_percentile": 16103.19, "90th_percentile": 16937.13, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "median_amount": 13457.47, "10th_percentile": 13163.53, "90th_percentile": 13751.41, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "median_amount": 13457.47, "10th_percentile": 13163.53, "90th_percentile": 13751.41, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "median_amount": 13457.47, "10th_percentile": 13163.53, "90th_percentile": 13751.41, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "median_amount": 13457.47, "10th_percentile": 13163.53, "90th_percentile": 13751.41, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "median_amount": 14952.76, "10th_percentile": 14626.16, "90th_percentile": 15279.36, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "median_amount": 14952.76, "10th_percentile": 14626.16, "90th_percentile": 15279.36, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Re-evaluated: HLB.800498362; Using historical claim(s); Scope: All Financial Classes; Cases: 3; Inpatient Services; 50% Billed", "median_amount": 24566.0, "10th_percentile": 24566.0, "90th_percentile": 24566.0, "count": "1 through 10", "methodology": "percent of total billed charges" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "gross_charge": 154591.73, "discounted_cash": 108214.22, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.796841889; Using historical claim(s); Scope: All Financial Classes; Cases: 15; All IP Services - OON; 100% Billed", "median_amount": 154496.97, "10th_percentile": 154496.97, "90th_percentile": 154496.97, "count": "15", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.796841889; Using historical claim(s); Scope: All Financial Classes; Cases: 15; All IP Services; 100% Billed", "median_amount": 154496.97, "10th_percentile": 154496.97, "90th_percentile": 154496.97, "count": "15", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.828984030; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services (Non-Contracted); 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services (Non-Contracted); 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services (Non-Contracted); 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.837917379; Using historical claim(s); Scope: All Financial Classes; Cases: 11; All IP Services (Non-Contracted); 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.784763212; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services (Non-Contracted); 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.796841889; Using historical claim(s); Scope: All Financial Classes; Cases: 15; All IP Services (Non-Contracted); 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.784763212; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 53131.0, "10th_percentile": 47622.69, "90th_percentile": 67501.68, "count": "18", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 53131.0, "10th_percentile": 47622.69, "90th_percentile": 67501.68, "count": "18", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services; 100% Billed", "median_amount": 53131.0, "10th_percentile": 47622.69, "90th_percentile": 67501.68, "count": "18", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.828984030; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 53131.0, "10th_percentile": 47622.69, "90th_percentile": 67501.68, "count": "18", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.784763212; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 54352.5, "10th_percentile": 48235.09, "90th_percentile": 68155.13, "count": "29", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.837917379; Using historical claim(s); Scope: All Financial Classes; Cases: 11; All IP Services; 100% Billed", "median_amount": 54352.5, "10th_percentile": 48235.09, "90th_percentile": 68155.13, "count": "29", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 54352.5, "10th_percentile": 48235.09, 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PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.828984030; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.837917379; Using historical claim(s); Scope: All Financial Classes; Cases: 11; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.784763212; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.796841889; Using historical claim(s); Scope: All Financial Classes; Cases: 15; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.828984030; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.837917379; Using historical claim(s); Scope: All Financial Classes; Cases: 11; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.784763212; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.796841889; Using historical claim(s); Scope: All Financial Classes; Cases: 15; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.828984030; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.837917379; Using historical claim(s); Scope: All Financial Classes; Cases: 11; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.784763212; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.796841889; Using historical claim(s); Scope: All Financial Classes; Cases: 15; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.796841889; Using historical claim(s); Scope: All Financial Classes; Cases: 15; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.784763212; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.837917379; Using historical claim(s); Scope: All Financial Classes; Cases: 11; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.828984030; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.828984030; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.837917379; Using historical claim(s); Scope: All Financial Classes; Cases: 11; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.784763212; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.796841889; Using historical claim(s); Scope: All Financial Classes; Cases: 15; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.796841889; Using historical claim(s); Scope: All Financial Classes; Cases: 15; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.784763212; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.837917379; Using historical claim(s); Scope: All Financial Classes; Cases: 11; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.828984030; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 57517.38, "10th_percentile": 48847.49, "90th_percentile": 113817.01, "count": "44", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Re-evaluated: HLB.796841889; Using historical claim(s); Scope: All Financial Classes; Cases: 15; Stoploss; 80% Billed", "median_amount": 123597.58, "10th_percentile": 123597.58, "90th_percentile": 123597.58, "count": "15", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_percentage": 30.0, "standard_charge_algorithm": "Re-evaluated: HLB.796841889; Using historical claim(s); Scope: All Financial Classes; Cases: 15; All IP Services; 30% Billed", "median_amount": 46349.09, "10th_percentile": 46349.09, "90th_percentile": 46349.09, "count": "15", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_percentage": 19.4, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 29972.43, "10th_percentile": 29972.43, "90th_percentile": 29972.43, "count": "15", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_percentage": 85.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 131322.44, "10th_percentile": 131322.44, "90th_percentile": 131322.44, "count": "15", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 126687.5, "10th_percentile": 126687.5, "90th_percentile": 126687.5, "count": "15", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_percentage": 40.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 61798.8, "10th_percentile": 61798.8, "90th_percentile": 61798.8, "count": "15", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_percentage": 40.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 61798.8, "10th_percentile": 61798.8, "90th_percentile": 61798.8, "count": "15", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: HLB.828984030; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All Inpatient Services; 70% Billed", "median_amount": 37191.7, "10th_percentile": 33335.88, "90th_percentile": 47251.18, "count": "18", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All Inpatient Services; 70% Billed", "median_amount": 37191.7, "10th_percentile": 33335.88, "90th_percentile": 47251.18, "count": "18", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All Inpatient Services; 70% Billed", "median_amount": 37191.7, "10th_percentile": 33335.88, "90th_percentile": 47251.18, "count": "18", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: 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"percent of total billed charges" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Re-evaluated: HLB.828984030; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services (Non-Contracted); 55% Billed", "median_amount": 29222.06, "10th_percentile": 26192.48, "90th_percentile": 37125.93, "count": "18", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.828984030; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 39% Billed", "median_amount": 20244.71, "10th_percentile": 18711.94, "90th_percentile": 25593.06, "count": "29", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.817769469; Using historical claim(s); Scope: All Financial Classes; Cases: 11; All IP Services; 39% Billed", "median_amount": 20244.71, "10th_percentile": 18711.94, "90th_percentile": 25593.06, "count": "29", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services; 39% Billed", "median_amount": 20244.71, "10th_percentile": 18711.94, "90th_percentile": 25593.06, "count": "29", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 39% Billed", 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[130]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 24458.63, "10th_percentile": 21705.79, "90th_percentile": 54878.86, "count": "33", "methodology": "percent of total billed charges" } ] } ] }, { "description": "ACYCLOVIR 5 % TOP OINT", "drug_information": { "unit": 30.0, "type": "GR" }, "code_information": [ { "code": "RX-8968", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "72578-0082-06", "type": "NDC" } ], "standard_charges": [ { "minimum": 64.0, "maximum": 273.5, "setting": "outpatient", "gross_charge": 273.5, "discounted_cash": 191.45, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 273.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 273.5, "10th_percentile": 273.5, "90th_percentile": 273.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 273.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 273.5, "10th_percentile": 273.5, "90th_percentile": 273.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 273.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 273.5, "10th_percentile": 273.5, "90th_percentile": 273.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 273.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 273.5, "10th_percentile": 273.5, "90th_percentile": 273.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 273.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 273.5, "10th_percentile": 273.5, "90th_percentile": 273.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": 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"median_amount": 273.5, "10th_percentile": 273.5, "90th_percentile": 273.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 273.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 273.5, "10th_percentile": 273.5, "90th_percentile": 273.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 136.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 136.75, "10th_percentile": 136.75, "90th_percentile": 136.75, "count": "0", "methodology": "percent of total billed 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Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 136.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 136.75, "10th_percentile": 136.75, "90th_percentile": 136.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 123.08, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 123.08, "10th_percentile": 123.08, "90th_percentile": 123.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 123.08, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 123.08, "10th_percentile": 123.08, "90th_percentile": 123.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 64.0, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 64.0, "10th_percentile": 64.0, "90th_percentile": 64.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 158.63, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 158.63, "10th_percentile": 158.63, "90th_percentile": 158.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 191.45, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 191.45, "10th_percentile": 191.45, "90th_percentile": 191.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" } ] } ] }, { "description": "ACYCLOVIR 800 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-8972", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "50268-0062-15", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.64, "maximum": 11.0, "setting": "outpatient", "gross_charge": 11.0, "discounted_cash": 7.7, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 11.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 11.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 11.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 11.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 11.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 11.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 11.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 11.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 11.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 4.95, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 4.95, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 4.95, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.74, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.85, "10th_percentile": 0.96, "90th_percentile": 2.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2.97, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.85, "10th_percentile": 0.96, "90th_percentile": 2.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2.97, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.85, "10th_percentile": 0.96, "90th_percentile": 2.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.74, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.85, "10th_percentile": 0.96, "90th_percentile": 2.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 5.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 5.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.64, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1.6, "10th_percentile": 0.83, "90th_percentile": 2.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 2.57, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1.6, "10th_percentile": 0.83, "90th_percentile": 2.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 6.38, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 6.38, "10th_percentile": 6.38, "90th_percentile": 6.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 7.7, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 7.7, "10th_percentile": 7.7, "90th_percentile": 7.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" } ] } ] }, { "description": "ACYCLOVIR 800 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-8972", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "60687-0867-11", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.78, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC 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": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC 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": "NMHC 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": "NMHC 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": "NMHC 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": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC 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": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 4.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 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 (Non-Contracted); 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1.8, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 1.8, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.08, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.08, "10th_percentile": 1.08, "90th_percentile": 1.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH 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": "NMH ADVOCATE IPA", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% 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 Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% 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 Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 1.28, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.28, "10th_percentile": 1.28, "90th_percentile": 1.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 4.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $4.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 4.0, "10th_percentile": 4.0, "90th_percentile": 4.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $4.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 4.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 4.0, "10th_percentile": 4.0, "90th_percentile": 4.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 2.33, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.33, "10th_percentile": 2.33, "90th_percentile": 2.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 2.59, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.59, "10th_percentile": 2.59, "90th_percentile": 2.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 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": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 3.28, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 3.28, "10th_percentile": 3.28, "90th_percentile": 3.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.32, "10th_percentile": 2.32, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 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": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% 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 procedures; 85% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 0.93, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.93, "10th_percentile": 0.93, "90th_percentile": 0.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.78, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 0.78, "10th_percentile": 0.78, "90th_percentile": 0.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 1.2, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% 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 OP Services; 30% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 1.41, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 1.41, "10th_percentile": 1.41, "90th_percentile": 1.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 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 OP; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4.0, "10th_percentile": 4.0, "90th_percentile": 4.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ACYCLOVIR SODIUM 50 MG/ML IV SOLN", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "RX-23128", "type": "CDM" }, { "code": "J0133", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "65219-0622-02", "type": "NDC" } ], "standard_charges": [ { "minimum": 3.74, "maximum": 124.0, "setting": "outpatient", "gross_charge": 22.75, "discounted_cash": 15.92, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 22.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 66.5, "10th_percentile": 31.5, "90th_percentile": 112.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 66.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 66.5, "10th_percentile": 31.5, "90th_percentile": 112.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 124.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 66.5, "10th_percentile": 31.5, "90th_percentile": 112.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 124.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 66.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 22.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 18.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 124.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 66.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 22.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 18.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 18.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 22.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 66.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 124.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 18.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 22.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 66.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 124.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 18.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 22.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 66.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 124.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 124.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 66.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 22.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 18.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 18.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 22.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 66.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 124.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 124.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 66.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 22.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 18.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 44.63, "10th_percentile": 19.77, "90th_percentile": 106.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 10.24, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.93, "10th_percentile": 14.18, "90th_percentile": 50.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 29.93, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.93, "10th_percentile": 14.18, "90th_percentile": 50.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 55.8, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.93, "10th_percentile": 14.18, "90th_percentile": 50.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 10.24, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.93, "10th_percentile": 14.18, "90th_percentile": 50.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 29.93, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.93, "10th_percentile": 14.18, "90th_percentile": 50.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 55.8, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.93, "10th_percentile": 14.18, "90th_percentile": 50.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 55.8, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.93, "10th_percentile": 14.18, "90th_percentile": 50.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 29.93, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.93, "10th_percentile": 14.18, "90th_percentile": 50.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 10.24, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.93, "10th_percentile": 14.18, "90th_percentile": 50.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 33.48, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 4.59, "90th_percentile": 27.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 17.96, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 4.59, "90th_percentile": 27.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 6.14, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 4.59, "90th_percentile": 27.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 5.0, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 4.59, "90th_percentile": 27.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 4.32, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 4.59, "90th_percentile": 27.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 4.32, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.05, "10th_percentile": 4.87, "90th_percentile": 28.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 6.14, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.05, "10th_percentile": 4.87, "90th_percentile": 28.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 17.96, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.05, "10th_percentile": 4.87, "90th_percentile": 28.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 33.48, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.05, "10th_percentile": 4.87, "90th_percentile": 28.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 11.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 33.25, "10th_percentile": 15.75, "90th_percentile": 56.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 33.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 33.25, "10th_percentile": 15.75, "90th_percentile": 56.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 62.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 33.25, "10th_percentile": 15.75, "90th_percentile": 56.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 11.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 33.25, "10th_percentile": 15.75, "90th_percentile": 56.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 33.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 33.25, "10th_percentile": 15.75, "90th_percentile": 56.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 62.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 33.25, "10th_percentile": 15.75, "90th_percentile": 56.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 29.02, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 10.44, "10th_percentile": 4.21, "90th_percentile": 24.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 15.56, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 10.44, "10th_percentile": 4.21, "90th_percentile": 24.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 5.32, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 10.44, "10th_percentile": 4.21, "90th_percentile": 24.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 3.74, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 10.44, "10th_percentile": 4.21, "90th_percentile": 24.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 15.93, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 46.55, "10th_percentile": 22.05, "90th_percentile": 78.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 46.55, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 46.55, "10th_percentile": 22.05, "90th_percentile": 78.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 86.8, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 46.55, "10th_percentile": 22.05, "90th_percentile": 78.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 13.2, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 38.57, "10th_percentile": 18.27, "90th_percentile": 65.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 38.57, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 38.57, "10th_percentile": 18.27, "90th_percentile": 65.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 71.92, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 38.57, "10th_percentile": 18.27, "90th_percentile": 65.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" } ] } ] }, { "description": "ADAPTA S PACEMAKER", "code_information": [ { "code": "SUP-117685", "type": "CDM" }, { "code": "C1785", "type": "HCPCS" }, { "code": "0275", "type": "RC" } ], "standard_charges": [ { "minimum": 3374.75, "maximum": 45028.43, "setting": "outpatient", "gross_charge": 45028.43, "discounted_cash": 31519.9, "payers_information": [ { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 17395.6, "10th_percentile": 17395.6, "90th_percentile": 17395.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 17395.6, "10th_percentile": 17395.6, "90th_percentile": 17395.6, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 17395.6, "10th_percentile": 17395.6, "90th_percentile": 17395.6, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 6958.24, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 6958.24, "10th_percentile": 6958.24, "90th_percentile": 6958.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 6958.24, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 6958.24, "10th_percentile": 6958.24, "90th_percentile": 6958.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 17395.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $17,395.60 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 17395.6, "10th_percentile": 17395.6, "90th_percentile": 17395.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $17,395.60 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 17395.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 17395.6, "10th_percentile": 17395.6, "90th_percentile": 17395.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 17395.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 17395.6, "10th_percentile": 17395.6, "90th_percentile": 17395.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 8697.8, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 8697.8, "10th_percentile": 8697.8, "90th_percentile": 8697.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 13916.48, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 13916.48, "10th_percentile": 13916.48, "90th_percentile": 13916.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 14264.39, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 14264.39, "10th_percentile": 14264.39, "90th_percentile": 14264.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 13916.48, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 13916.48, "10th_percentile": 13916.48, "90th_percentile": 13916.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 11307.14, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 11307.14, "10th_percentile": 11307.14, "90th_percentile": 11307.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 14786.26, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 14786.26, "10th_percentile": 14786.26, "90th_percentile": 14786.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 5218.68, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 5218.68, "10th_percentile": 5218.68, "90th_percentile": 5218.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 3374.75, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 3374.75, "10th_percentile": 3374.75, "90th_percentile": 3374.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 5566.59, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5566.59, "10th_percentile": 5566.59, "90th_percentile": 5566.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 6140.65, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 6140.65, "10th_percentile": 6140.65, "90th_percentile": 6140.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 10141.63, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10141.63, "10th_percentile": 10141.63, "90th_percentile": 10141.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 4053.17, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4053.17, "10th_percentile": 4053.17, "90th_percentile": 4053.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 11272.35, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11272.35, "10th_percentile": 11272.35, "90th_percentile": 11272.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 10106.84, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10106.84, "10th_percentile": 10106.84, "90th_percentile": 10106.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 45028.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 34997.97, "10th_percentile": 28268.03, "90th_percentile": 42619.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 36999.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 34997.97, "10th_percentile": 28268.03, "90th_percentile": 42619.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 32996.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 34997.97, "10th_percentile": 28268.03, "90th_percentile": 42619.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 26241.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 34997.97, "10th_percentile": 28268.03, "90th_percentile": 42619.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 45028.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 32996.24, "10th_percentile": 20188.27, "90th_percentile": 41816.94, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 36999.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 32996.24, "10th_percentile": 20188.27, "90th_percentile": 41816.94, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 32996.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 32996.24, "10th_percentile": 20188.27, "90th_percentile": 41816.94, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 26241.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 32996.24, "10th_percentile": 20188.27, "90th_percentile": 41816.94, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 16152.68, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 32996.24, "10th_percentile": 20188.27, "90th_percentile": 41816.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 45028.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 29618.95, "10th_percentile": 16774.14, "90th_percentile": 41014.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 36999.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 29618.95, "10th_percentile": 16774.14, "90th_percentile": 41014.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 32996.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 29618.95, "10th_percentile": 16774.14, "90th_percentile": 41014.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 26241.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 29618.95, "10th_percentile": 16774.14, "90th_percentile": 41014.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 17395.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 29618.95, "10th_percentile": 16774.14, "90th_percentile": 41014.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 16152.68, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 29618.95, "10th_percentile": 16774.14, "90th_percentile": 41014.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 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100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 45028.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 29618.95, "10th_percentile": 16774.14, "90th_percentile": 41014.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 36999.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 29618.95, "10th_percentile": 16774.14, "90th_percentile": 41014.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 32996.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 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100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 16152.68, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 29618.95, "10th_percentile": 16774.14, "90th_percentile": 41014.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 12157.68, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7997.11, "10th_percentile": 4529.02, "90th_percentile": 11073.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 20262.79, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15749.09, "10th_percentile": 12720.62, "90th_percentile": 19178.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 20262.79, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15749.09, "10th_percentile": 12720.62, "90th_percentile": 19178.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 22514.22, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 17498.99, "10th_percentile": 14134.02, "90th_percentile": 21309.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 10536.65, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 8189.52, "10th_percentile": 6614.72, "90th_percentile": 9973.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 26116.49, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 20298.83, "10th_percentile": 16395.46, "90th_percentile": 24719.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 20262.79, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14848.31, "10th_percentile": 9420.31, "90th_percentile": 18817.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 22514.22, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 16498.12, "10th_percentile": 10467.01, "90th_percentile": 20908.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 12157.68, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9449.45, "10th_percentile": 7632.37, "90th_percentile": 11507.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 31519.9, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 24498.58, "10th_percentile": 19787.62, "90th_percentile": 29833.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 4696.81, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7997.11, "10th_percentile": 4529.02, "90th_percentile": 11073.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 4361.22, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7997.11, "10th_percentile": 4529.02, "90th_percentile": 11073.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 7828.02, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14848.31, "10th_percentile": 9420.31, "90th_percentile": 18817.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 8697.8, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 16498.12, "10th_percentile": 10467.01, "90th_percentile": 20908.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 7085.25, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7997.11, "10th_percentile": 4529.02, "90th_percentile": 11073.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 11808.75, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15749.09, "10th_percentile": 12720.62, "90th_percentile": 19178.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 11808.75, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15749.09, "10th_percentile": 12720.62, "90th_percentile": 19178.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 13120.83, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 17498.99, "10th_percentile": 14134.02, "90th_percentile": 21309.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 6140.55, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 8189.52, "10th_percentile": 6614.72, "90th_percentile": 9973.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 15220.16, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 20298.83, "10th_percentile": 16395.46, "90th_percentile": 24719.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 11808.75, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14848.31, "10th_percentile": 9420.31, "90th_percentile": 18817.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 13120.83, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 16498.12, "10th_percentile": 10467.01, "90th_percentile": 20908.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 7085.25, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9449.45, "10th_percentile": 7632.37, "90th_percentile": 11507.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 18369.16, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 24498.58, "10th_percentile": 19787.62, "90th_percentile": 29833.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 8908.98, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7997.11, "10th_percentile": 4529.02, "90th_percentile": 11073.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 14848.31, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15749.09, "10th_percentile": 12720.62, "90th_percentile": 19178.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 14848.31, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15749.09, "10th_percentile": 12720.62, "90th_percentile": 19178.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 16498.12, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 17498.99, "10th_percentile": 14134.02, "90th_percentile": 21309.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 7721.12, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 8189.52, "10th_percentile": 6614.72, "90th_percentile": 9973.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 19137.82, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 20298.83, "10th_percentile": 16395.46, "90th_percentile": 24719.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 14848.31, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14848.31, "10th_percentile": 9420.31, "90th_percentile": 18817.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 16498.12, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 16498.12, "10th_percentile": 10467.01, "90th_percentile": 20908.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 8908.98, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9449.45, "10th_percentile": 7632.37, "90th_percentile": 11507.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 23097.37, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 24498.58, "10th_percentile": 19787.62, "90th_percentile": 29833.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 9989.92, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7997.11, "10th_percentile": 4529.02, "90th_percentile": 11073.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 16649.87, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15749.09, "10th_percentile": 12720.62, "90th_percentile": 19178.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 16649.87, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15749.09, "10th_percentile": 12720.62, "90th_percentile": 19178.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 18499.85, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 17498.99, "10th_percentile": 14134.02, "90th_percentile": 21309.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 8657.93, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 8189.52, "10th_percentile": 6614.72, "90th_percentile": 9973.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 21459.83, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 20298.83, "10th_percentile": 16395.46, "90th_percentile": 24719.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 16649.87, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14848.31, "10th_percentile": 9420.31, "90th_percentile": 18817.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 18499.85, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 16498.12, "10th_percentile": 10467.01, "90th_percentile": 20908.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 9989.92, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9449.45, "10th_percentile": 7632.37, "90th_percentile": 11507.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 25899.79, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 24498.58, "10th_percentile": 19787.62, "90th_percentile": 29833.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" } ] } ] }, { "description": "ADAPTER CATHETER/SYRINGE/LUER STERILE", "code_information": [ { "code": "SUP-393490", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 2.43, "maximum": 10.4, "setting": "outpatient", "gross_charge": 10.4, "discounted_cash": 7.28, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.4, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.4, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.4, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.4, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.4, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.4, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.4, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.4, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 10.4, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 4.68, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 4.68, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 4.68, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2.81, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.81, "10th_percentile": 2.81, "90th_percentile": 2.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2.81, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.81, "10th_percentile": 2.81, "90th_percentile": 2.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 5.2, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 5.2, "10th_percentile": 5.2, "90th_percentile": 5.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 5.2, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 5.2, "10th_percentile": 5.2, "90th_percentile": 5.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 2.43, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 2.43, "10th_percentile": 2.43, "90th_percentile": 2.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 6.03, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 6.03, "10th_percentile": 6.03, "90th_percentile": 6.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 7.28, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 7.28, "10th_percentile": 7.28, "90th_percentile": 7.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" } ] } ] }, { "description": "ADAPTER EXTERNAL FIX SHORT WIRE BOLT", "code_information": [ { "code": "SUP-344141", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 186.61, "maximum": 3228.61, "setting": "outpatient", "gross_charge": 893.18, "discounted_cash": 625.23, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 893.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 961.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1890.05, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3228.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 893.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 961.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1890.05, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3228.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3228.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1890.05, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 961.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 893.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 893.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 961.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1890.05, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3228.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3228.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1890.05, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 961.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 893.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 893.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 961.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1890.05, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3228.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1890.05, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2559.33, "10th_percentile": 2023.91, "90th_percentile": 3094.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3228.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2559.33, "10th_percentile": 2023.91, "90th_percentile": 3094.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3228.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1890.05, "10th_percentile": 1092.55, "90th_percentile": 2960.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1890.05, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1890.05, "10th_percentile": 1092.55, "90th_percentile": 2960.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 893.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1890.05, "10th_percentile": 1092.55, "90th_percentile": 2960.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 893.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 961.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1890.05, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 3228.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1425.98, "10th_percentile": 913.8, "90th_percentile": 2827.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 850.52, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1151.69, "10th_percentile": 910.76, "90th_percentile": 1392.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 1452.87, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1151.69, "10th_percentile": 910.76, "90th_percentile": 1392.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 850.52, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1151.69, "10th_percentile": 910.76, "90th_percentile": 1392.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1452.87, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1151.69, "10th_percentile": 910.76, "90th_percentile": 1392.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 432.86, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 850.52, "10th_percentile": 516.39, "90th_percentile": 1332.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 850.52, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 850.52, "10th_percentile": 516.39, "90th_percentile": 1332.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1452.87, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 850.52, "10th_percentile": 516.39, "90th_percentile": 1332.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 871.72, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 385.01, "10th_percentile": 246.73, "90th_percentile": 763.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 510.31, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 385.01, "10th_percentile": 246.73, "90th_percentile": 763.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 259.72, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 385.01, "10th_percentile": 246.73, "90th_percentile": 763.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 241.16, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 385.01, "10th_percentile": 246.73, "90th_percentile": 763.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 871.72, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 691.01, "10th_percentile": 546.45, "90th_percentile": 835.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 510.31, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 691.01, "10th_percentile": 546.45, "90th_percentile": 835.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1614.31, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1279.67, "10th_percentile": 1011.96, "90th_percentile": 1547.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 945.03, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1279.67, "10th_percentile": 1011.96, "90th_percentile": 1547.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 480.96, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 945.03, "10th_percentile": 573.77, "90th_percentile": 1480.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 945.03, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 945.03, "10th_percentile": 573.77, "90th_percentile": 1480.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1614.31, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 945.03, "10th_percentile": 573.77, "90th_percentile": 1480.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 755.49, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 598.88, "10th_percentile": 473.59, "90th_percentile": 724.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 442.27, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 598.88, "10th_percentile": 473.59, "90th_percentile": 724.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1096.23, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1484.41, "10th_percentile": 1173.87, "90th_percentile": 1794.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1872.59, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1484.41, "10th_percentile": 1173.87, "90th_percentile": 1794.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 2260.03, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1791.54, "10th_percentile": 1416.74, "90th_percentile": 2166.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1323.04, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1791.54, "10th_percentile": 1416.74, "90th_percentile": 2166.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 384.76, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 384.76, "10th_percentile": 384.76, "90th_percentile": 384.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 384.76, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 384.76, "10th_percentile": 384.76, "90th_percentile": 384.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 339.55, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 339.55, "10th_percentile": 339.55, "90th_percentile": 339.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 788.77, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 788.77, "10th_percentile": 788.77, "90th_percentile": 788.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 288.57, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 288.57, "10th_percentile": 288.57, "90th_percentile": 288.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 480.96, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 480.96, "10th_percentile": 480.96, "90th_percentile": 480.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 560.79, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 560.79, "10th_percentile": 560.79, "90th_percentile": 560.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 307.81, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 307.81, "10th_percentile": 307.81, "90th_percentile": 307.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 623.32, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 623.32, "10th_percentile": 623.32, "90th_percentile": 623.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 558.87, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 558.87, "10th_percentile": 558.87, "90th_percentile": 558.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 186.61, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 186.61, "10th_percentile": 186.61, "90th_percentile": 186.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 961.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 961.91, "10th_percentile": 961.91, "90th_percentile": 961.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 817.62, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 817.62, "10th_percentile": 817.62, "90th_percentile": 817.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 625.24, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 625.24, "10th_percentile": 625.24, "90th_percentile": 625.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 769.53, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 769.53, "10th_percentile": 769.53, "90th_percentile": 769.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 961.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $961.91 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 961.91, "10th_percentile": 961.91, "90th_percentile": 961.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $961.91 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 224.13, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 224.13, "10th_percentile": 224.13, "90th_percentile": 224.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 769.53, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 769.53, "10th_percentile": 769.53, "90th_percentile": 769.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 961.91, "10th_percentile": 961.91, "90th_percentile": 961.91, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 961.91, "10th_percentile": 961.91, "90th_percentile": 961.91, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 961.91, "10th_percentile": 961.91, "90th_percentile": 961.91, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 961.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 961.91, "10th_percentile": 961.91, "90th_percentile": 961.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "ADAPTER HUM 4CM 30DEG TPR FX MINI COMPRESS", "code_information": [ { "code": "SUP-419148", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 730.91, "maximum": 7146.41, "setting": "outpatient", "gross_charge": 3767.58, "discounted_cash": 2637.31, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3767.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5456.99, "10th_percentile": 4105.46, "90th_percentile": 6808.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7146.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5456.99, "10th_percentile": 4105.46, "90th_percentile": 6808.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3767.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5456.99, "10th_percentile": 4105.46, "90th_percentile": 6808.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7146.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5456.99, "10th_percentile": 4105.46, "90th_percentile": 6808.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7146.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5456.99, "10th_percentile": 4105.46, "90th_percentile": 6808.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3767.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5456.99, "10th_percentile": 4105.46, "90th_percentile": 6808.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7146.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5456.99, "10th_percentile": 4105.46, "90th_percentile": 6808.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3767.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5456.99, "10th_percentile": 4105.46, "90th_percentile": 6808.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3767.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5456.99, "10th_percentile": 4105.46, "90th_percentile": 6808.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7146.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5456.99, "10th_percentile": 4105.46, "90th_percentile": 6808.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7146.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7146.41, "10th_percentile": 7146.41, "90th_percentile": 7146.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7146.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7146.41, "10th_percentile": 7146.41, "90th_percentile": 7146.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3767.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5456.99, "10th_percentile": 4105.46, "90th_percentile": 6808.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7146.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5456.99, "10th_percentile": 4105.46, "90th_percentile": 6808.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 3767.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 5456.99, "10th_percentile": 4105.46, "90th_percentile": 6808.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 7146.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 5456.99, "10th_percentile": 4105.46, "90th_percentile": 6808.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 3215.88, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3215.88, "10th_percentile": 3215.88, "90th_percentile": 3215.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3215.88, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3215.88, "10th_percentile": 3215.88, "90th_percentile": 3215.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1695.41, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2455.64, "10th_percentile": 1847.46, "90th_percentile": 3063.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3215.88, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2455.64, "10th_percentile": 1847.46, "90th_percentile": 3063.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1929.53, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1929.53, "10th_percentile": 1929.53, "90th_percentile": 1929.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1929.53, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1473.39, "10th_percentile": 1108.48, "90th_percentile": 1838.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1017.25, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1473.39, "10th_percentile": 1108.48, "90th_percentile": 1838.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1883.79, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2728.5, "10th_percentile": 2052.73, "90th_percentile": 3404.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3573.21, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2728.5, "10th_percentile": 2052.73, "90th_percentile": 3404.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3573.21, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3573.21, "10th_percentile": 3573.21, "90th_percentile": 3573.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1672.26, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1672.26, "10th_percentile": 1672.26, "90th_percentile": 1672.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 5002.49, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 5002.49, "10th_percentile": 5002.49, "90th_percentile": 5002.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 4144.92, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 4144.92, "10th_percentile": 4144.92, "90th_percentile": 4144.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 2441.39, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2464.5, "10th_percentile": 2464.5, "90th_percentile": 2464.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 2188.96, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2143.36, "10th_percentile": 2143.36, "90th_percentile": 2143.36, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 877.85, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 915.61, "10th_percentile": 915.61, "90th_percentile": 915.61, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 730.91, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 1051.1, "10th_percentile": 1051.1, "90th_percentile": 1051.1, "count": "12", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 1507.03, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 1507.03, "10th_percentile": 1507.03, "90th_percentile": 1507.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 1507.03, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 1507.03, "10th_percentile": 1507.03, "90th_percentile": 1507.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 1130.27, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 1290.36, "10th_percentile": 1290.36, "90th_percentile": 1290.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 1329.96, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 1329.96, "10th_percentile": 1329.96, "90th_percentile": 1329.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 3202.44, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 3202.44, "10th_percentile": 3202.44, "90th_percentile": 3202.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 3014.06, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 3014.06, "10th_percentile": 3014.06, "90th_percentile": 3014.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2448.93, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 2448.93, "10th_percentile": 2448.93, "90th_percentile": 2448.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 3014.06, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3014.06, "10th_percentile": 3014.06, "90th_percentile": 3014.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 1205.63, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1205.63, "10th_percentile": 1205.63, "90th_percentile": 1205.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 3089.42, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 3089.42, "10th_percentile": 3089.42, "90th_percentile": 3089.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 3767.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,767.58 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 3767.58, "10th_percentile": 3767.58, "90th_percentile": 3767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,767.58 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3767.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3767.58, "10th_percentile": 3767.58, "90th_percentile": 3767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 2196.5, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2196.5, "10th_percentile": 2196.5, "90th_percentile": 2196.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 1883.79, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1883.79, "10th_percentile": 1883.79, "90th_percentile": 1883.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 3767.58, "10th_percentile": 3767.58, "90th_percentile": 3767.58, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 3767.58, "10th_percentile": 3767.58, "90th_percentile": 3767.58, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3767.58, "10th_percentile": 3767.58, "90th_percentile": 3767.58, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3767.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3767.58, "10th_percentile": 3767.58, "90th_percentile": 3767.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "ADAPTER IV FOUR-SPIKE C7108 5", "code_information": [ { "code": "SUP-302424", "type": "CDM" }, { "code": "27000001", "type": "LOCAL" }, { "code": "0270", "type": "RC" } ], "standard_charges": [ { "minimum": 81.13, "maximum": 716.37, "setting": "outpatient", "gross_charge": 300.48, "discounted_cash": 210.34, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 300.48, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 508.43, "10th_percentile": 342.07, "90th_percentile": 674.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 716.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 508.43, "10th_percentile": 342.07, "90th_percentile": 674.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 300.48, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 508.43, "10th_percentile": 342.07, "90th_percentile": 674.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 716.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 508.43, "10th_percentile": 342.07, "90th_percentile": 674.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 300.48, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 508.43, "10th_percentile": 342.07, "90th_percentile": 674.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 716.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 508.43, "10th_percentile": 342.07, "90th_percentile": 674.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 716.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 716.37, "10th_percentile": 716.37, "90th_percentile": 716.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 300.48, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 508.43, "10th_percentile": 342.07, "90th_percentile": 674.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 716.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 508.43, "10th_percentile": 342.07, "90th_percentile": 674.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 716.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 508.43, "10th_percentile": 342.07, "90th_percentile": 674.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 300.48, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 508.43, "10th_percentile": 342.07, "90th_percentile": 674.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 716.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 508.43, "10th_percentile": 342.07, "90th_percentile": 674.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 300.48, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 508.43, "10th_percentile": 342.07, "90th_percentile": 674.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 300.48, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 508.43, "10th_percentile": 342.07, "90th_percentile": 674.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 716.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 508.43, "10th_percentile": 342.07, "90th_percentile": 674.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 300.48, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 508.43, "10th_percentile": 342.07, "90th_percentile": 674.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 716.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 508.43, "10th_percentile": 342.07, "90th_percentile": 674.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 193.42, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 137.27, "10th_percentile": 92.36, "90th_percentile": 182.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 81.13, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 137.27, "10th_percentile": 92.36, "90th_percentile": 182.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 322.37, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 322.37, "10th_percentile": 322.37, "90th_percentile": 322.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 322.37, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 322.37, "10th_percentile": 322.37, "90th_percentile": 322.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 358.19, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 358.19, "10th_percentile": 358.19, "90th_percentile": 358.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 167.63, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 167.63, "10th_percentile": 167.63, "90th_percentile": 167.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 415.49, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 415.49, "10th_percentile": 415.49, "90th_percentile": 415.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 322.37, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 322.37, "10th_percentile": 322.37, "90th_percentile": 322.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 358.19, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 358.19, "10th_percentile": 358.19, "90th_percentile": 358.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 193.42, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 193.42, "10th_percentile": 193.42, "90th_percentile": 193.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 501.46, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 501.46, "10th_percentile": 501.46, "90th_percentile": 501.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" } ] } ] }, { "description": "ADAPTER PHOTONGUIDE ILLUMINATED RETRACTOR SYSTEM INVUITY", "code_information": [ { "code": "SUP-416494", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 166.45, "maximum": 2604.27, "setting": "outpatient", "gross_charge": 2604.27, "discounted_cash": 1822.99, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2604.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2604.27, "10th_percentile": 2604.27, "90th_percentile": 2604.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2604.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2604.27, "10th_percentile": 2604.27, "90th_percentile": 2604.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2604.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2604.27, "10th_percentile": 2604.27, "90th_percentile": 2604.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2604.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2604.27, "10th_percentile": 2604.27, "90th_percentile": 2604.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2604.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2604.27, "10th_percentile": 2604.27, "90th_percentile": 2604.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2604.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2604.27, "10th_percentile": 2604.27, "90th_percentile": 2604.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2604.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2604.27, "10th_percentile": 2604.27, "90th_percentile": 2604.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2604.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2604.27, "10th_percentile": 2604.27, "90th_percentile": 2604.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2604.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 2604.27, "10th_percentile": 2604.27, "90th_percentile": 2604.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 1171.92, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1171.92, "10th_percentile": 1171.92, "90th_percentile": 1171.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1171.92, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1171.92, "10th_percentile": 1171.92, "90th_percentile": 1171.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1171.92, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1171.92, "10th_percentile": 1171.92, "90th_percentile": 1171.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 192.06, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 447.61, "10th_percentile": 243.17, "90th_percentile": 652.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 703.15, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 447.61, "10th_percentile": 243.17, "90th_percentile": 652.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 192.06, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 447.61, "10th_percentile": 243.17, "90th_percentile": 652.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 703.15, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 447.61, "10th_percentile": 243.17, "90th_percentile": 652.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1302.14, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1302.14, "10th_percentile": 1302.14, "90th_percentile": 1302.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1302.14, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1302.14, "10th_percentile": 1302.14, "90th_percentile": 1302.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 166.45, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 387.92, "10th_percentile": 210.75, "90th_percentile": 565.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 609.4, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 387.92, "10th_percentile": 210.75, "90th_percentile": 565.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1510.48, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1510.48, "10th_percentile": 1510.48, "90th_percentile": 1510.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1822.99, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1822.99, "10th_percentile": 1822.99, "90th_percentile": 1822.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" } ] } ] }, { "description": "ADAPTER PIN APEX SHRT 3-6MM", "code_information": [ { "code": "SUP-350041", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 285.41, "maximum": 4937.88, "setting": "outpatient", "gross_charge": 1366.05, "discounted_cash": 956.23, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1366.05, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1471.16, "10th_percentile": 1387.07, "90th_percentile": 4244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1471.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1471.16, "10th_percentile": 1387.07, "90th_percentile": 4244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4937.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1471.16, "10th_percentile": 1387.07, "90th_percentile": 4244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1366.05, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1471.16, "10th_percentile": 1387.07, "90th_percentile": 4244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1471.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1471.16, "10th_percentile": 1387.07, "90th_percentile": 4244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4937.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1471.16, "10th_percentile": 1387.07, "90th_percentile": 4244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4937.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1471.16, "10th_percentile": 1387.07, "90th_percentile": 4244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1471.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1471.16, "10th_percentile": 1387.07, "90th_percentile": 4244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1366.05, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1471.16, "10th_percentile": 1387.07, "90th_percentile": 4244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1366.05, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1471.16, "10th_percentile": 1387.07, "90th_percentile": 4244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1471.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1471.16, "10th_percentile": 1387.07, "90th_percentile": 4244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4937.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1471.16, "10th_percentile": 1387.07, "90th_percentile": 4244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1366.05, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1471.16, "10th_percentile": 1387.07, "90th_percentile": 4244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1471.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1471.16, "10th_percentile": 1387.07, "90th_percentile": 4244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4937.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1471.16, "10th_percentile": 1387.07, "90th_percentile": 4244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1366.05, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1471.16, "10th_percentile": 1387.07, "90th_percentile": 4244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1471.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1471.16, "10th_percentile": 1387.07, "90th_percentile": 4244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4937.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1471.16, "10th_percentile": 1387.07, "90th_percentile": 4244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4937.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4937.88, "10th_percentile": 4937.88, "90th_percentile": 4937.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1366.05, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3151.97, "10th_percentile": 1723.23, "90th_percentile": 4580.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4937.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3151.97, "10th_percentile": 1723.23, "90th_percentile": 4580.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1366.05, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1471.16, "10th_percentile": 1387.07, "90th_percentile": 4244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1471.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1471.16, "10th_percentile": 1387.07, "90th_percentile": 4244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 4937.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1471.16, "10th_percentile": 1387.07, "90th_percentile": 4244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 2222.05, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2222.05, "10th_percentile": 2222.05, "90th_percentile": 2222.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2222.05, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2222.05, "10th_percentile": 2222.05, "90th_percentile": 2222.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 662.02, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1442.04, "10th_percentile": 818.02, "90th_percentile": 2066.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2222.05, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1442.04, "10th_percentile": 818.02, "90th_percentile": 2066.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 368.83, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 397.21, "10th_percentile": 374.51, "90th_percentile": 1146.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 397.21, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 397.21, "10th_percentile": 374.51, "90th_percentile": 1146.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1333.23, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 397.21, "10th_percentile": 374.51, "90th_percentile": 1146.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1333.23, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1333.23, "10th_percentile": 1333.23, "90th_percentile": 1333.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2468.94, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2468.94, "10th_percentile": 2468.94, "90th_percentile": 2468.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2468.94, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1602.26, "10th_percentile": 908.92, "90th_percentile": 2295.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 735.58, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1602.26, "10th_percentile": 908.92, "90th_percentile": 2295.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1155.46, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1155.46, "10th_percentile": 1155.46, "90th_percentile": 1155.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 2863.97, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 2863.97, "10th_percentile": 2863.97, "90th_percentile": 2863.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 3456.52, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 3456.52, "10th_percentile": 3456.52, "90th_percentile": 3456.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 588.46, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 588.46, "10th_percentile": 588.46, "90th_percentile": 588.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 588.46, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 588.46, "10th_percentile": 588.46, "90th_percentile": 588.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 519.32, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 519.32, "10th_percentile": 519.32, "90th_percentile": 519.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 1206.35, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 1206.35, "10th_percentile": 1206.35, "90th_percentile": 1206.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 441.35, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 441.35, "10th_percentile": 441.35, "90th_percentile": 441.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 735.58, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 735.58, "10th_percentile": 735.58, "90th_percentile": 735.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 857.69, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 857.69, "10th_percentile": 857.69, "90th_percentile": 857.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 470.77, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 470.77, "10th_percentile": 470.77, "90th_percentile": 470.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 953.31, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 953.31, "10th_percentile": 953.31, "90th_percentile": 953.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 854.74, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 854.74, "10th_percentile": 854.74, "90th_percentile": 854.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 285.41, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 285.41, "10th_percentile": 285.41, "90th_percentile": 285.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1471.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1471.16, "10th_percentile": 1471.16, "90th_percentile": 1471.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 1250.49, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 1250.49, "10th_percentile": 1250.49, "90th_percentile": 1250.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 956.25, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 956.25, "10th_percentile": 956.25, "90th_percentile": 956.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 1176.93, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 1176.93, "10th_percentile": 1176.93, "90th_percentile": 1176.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 1471.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,471.16 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1471.16, "10th_percentile": 1471.16, "90th_percentile": 1471.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,471.16 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 342.78, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 342.78, "10th_percentile": 342.78, "90th_percentile": 342.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 1176.93, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 1176.93, "10th_percentile": 1176.93, "90th_percentile": 1176.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 1471.16, "10th_percentile": 1471.16, "90th_percentile": 1471.16, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 1471.16, "10th_percentile": 1471.16, "90th_percentile": 1471.16, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1471.16, "10th_percentile": 1471.16, "90th_percentile": 1471.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1471.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1471.16, "10th_percentile": 1471.16, "90th_percentile": 1471.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "ADAPTER Y ANGIO GATEWAY PLUS M001153223", "code_information": [ { "code": "SUP-351017", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 10.82, "maximum": 230.95, "setting": "outpatient", "gross_charge": 230.95, "discounted_cash": 161.66, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 230.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 169.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 82.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 230.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 169.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 82.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 82.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 169.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 230.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 230.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 169.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 82.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 82.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 169.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 230.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 82.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 169.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 230.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 169.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 200.09, "10th_percentile": 175.4, "90th_percentile": 224.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 230.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 200.09, "10th_percentile": 175.4, "90th_percentile": 224.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 230.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 169.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 82.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 82.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 169.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 230.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 169.23, "10th_percentile": 100.13, "90th_percentile": 218.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 76.15, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 90.04, "10th_percentile": 78.93, "90th_percentile": 101.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 103.93, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 90.04, "10th_percentile": 78.93, "90th_percentile": 101.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 76.15, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 90.04, "10th_percentile": 78.93, "90th_percentile": 101.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 103.93, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 90.04, "10th_percentile": 78.93, "90th_percentile": 101.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 76.15, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 90.04, "10th_percentile": 78.93, "90th_percentile": 101.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 103.93, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 90.04, "10th_percentile": 78.93, "90th_percentile": 101.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 62.36, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 34.03, "10th_percentile": 15.45, "90th_percentile": 57.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 45.69, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 34.03, "10th_percentile": 15.45, "90th_percentile": 57.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 22.37, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 34.03, "10th_percentile": 15.45, "90th_percentile": 57.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 12.48, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 34.03, "10th_percentile": 15.45, "90th_percentile": 57.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 62.36, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.69, "10th_percentile": 19.12, "90th_percentile": 59.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 45.69, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.69, "10th_percentile": 19.12, "90th_percentile": 59.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 12.48, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.69, "10th_percentile": 19.12, "90th_percentile": 59.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 115.48, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 100.05, "10th_percentile": 87.71, "90th_percentile": 112.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 84.62, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 100.05, "10th_percentile": 87.71, "90th_percentile": 112.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 84.62, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 100.05, "10th_percentile": 87.71, "90th_percentile": 112.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 115.48, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 100.05, "10th_percentile": 87.71, "90th_percentile": 112.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 10.82, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 39.6, "10th_percentile": 16.58, "90th_percentile": 51.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 39.6, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 39.6, "10th_percentile": 16.58, "90th_percentile": 51.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 54.04, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 39.6, "10th_percentile": 16.58, "90th_percentile": 51.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 98.15, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 116.05, "10th_percentile": 101.73, "90th_percentile": 130.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 133.95, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 116.05, "10th_percentile": 101.73, "90th_percentile": 130.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 118.46, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 140.06, "10th_percentile": 122.78, "90th_percentile": 157.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 161.67, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 140.06, "10th_percentile": 122.78, "90th_percentile": 157.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" } ] } ] }, { "description": "ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "RX-85043", "type": "CDM" }, { "code": "J0153", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "23155-0258-31", "type": "NDC" } ], "standard_charges": [ { "minimum": 105.01, "maximum": 448.75, "setting": "outpatient", "gross_charge": 448.75, "discounted_cash": 314.12, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 448.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 448.75, "10th_percentile": 448.75, "90th_percentile": 448.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 448.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 448.75, "10th_percentile": 448.75, "90th_percentile": 448.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 448.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 448.75, "10th_percentile": 448.75, "90th_percentile": 448.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 448.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 448.75, "10th_percentile": 448.75, "90th_percentile": 448.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 448.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 448.75, "10th_percentile": 448.75, "90th_percentile": 448.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 448.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 448.75, "10th_percentile": 448.75, "90th_percentile": 448.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 448.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 448.75, "10th_percentile": 448.75, "90th_percentile": 448.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 448.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 448.75, "10th_percentile": 448.75, "90th_percentile": 448.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 448.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 448.75, "10th_percentile": 448.75, "90th_percentile": 448.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 201.94, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 201.94, "10th_percentile": 201.94, "90th_percentile": 201.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 201.94, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 201.94, "10th_percentile": 201.94, "90th_percentile": 201.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 201.94, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 201.94, "10th_percentile": 201.94, "90th_percentile": 201.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 121.16, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 121.16, "10th_percentile": 121.16, "90th_percentile": 121.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 121.16, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 121.16, "10th_percentile": 121.16, "90th_percentile": 121.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 224.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 224.38, "10th_percentile": 224.38, "90th_percentile": 224.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 224.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 224.38, "10th_percentile": 224.38, "90th_percentile": 224.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 105.01, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 105.01, "10th_percentile": 105.01, "90th_percentile": 105.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 314.13, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 314.13, "10th_percentile": 314.13, "90th_percentile": 314.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 260.28, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 260.28, "10th_percentile": 260.28, "90th_percentile": 260.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" } ] } ] }, { "description": "ADHESIVE REINF STPL LN GEL PERI-STRIPS DRY", "code_information": [ { "code": "SUP-114877", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 13.45, "maximum": 131.53, "setting": "outpatient", "gross_charge": 131.53, "discounted_cash": 92.07, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 131.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 69.34, "10th_percentile": 65.38, "90th_percentile": 119.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 69.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 69.34, "10th_percentile": 65.38, "90th_percentile": 119.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 64.39, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 69.34, "10th_percentile": 65.38, "90th_percentile": 119.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 131.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 69.34, "10th_percentile": 65.38, "90th_percentile": 119.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 69.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 69.34, "10th_percentile": 65.38, "90th_percentile": 119.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 64.39, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 69.34, "10th_percentile": 65.38, "90th_percentile": 119.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 131.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 69.34, "10th_percentile": 65.38, "90th_percentile": 119.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 69.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 69.34, "10th_percentile": 65.38, "90th_percentile": 119.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 64.39, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 69.34, "10th_percentile": 65.38, "90th_percentile": 119.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 64.39, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 69.34, "10th_percentile": 65.38, "90th_percentile": 119.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 69.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 69.34, "10th_percentile": 65.38, "90th_percentile": 119.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 131.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 69.34, "10th_percentile": 65.38, "90th_percentile": 119.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 64.39, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 69.34, "10th_percentile": 65.38, "90th_percentile": 119.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 69.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 69.34, "10th_percentile": 65.38, "90th_percentile": 119.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 131.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 69.34, "10th_percentile": 65.38, "90th_percentile": 119.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 64.39, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 69.34, "10th_percentile": 65.38, "90th_percentile": 119.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 69.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 69.34, "10th_percentile": 65.38, "90th_percentile": 119.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 131.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 69.34, "10th_percentile": 65.38, "90th_percentile": 119.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 131.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 131.53, "10th_percentile": 131.53, "90th_percentile": 131.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 64.39, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 97.96, "10th_percentile": 71.1, "90th_percentile": 124.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 131.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 97.96, "10th_percentile": 71.1, "90th_percentile": 124.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 131.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 69.34, "10th_percentile": 65.38, "90th_percentile": 119.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 69.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 69.34, "10th_percentile": 65.38, "90th_percentile": 119.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 64.39, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 69.34, "10th_percentile": 65.38, "90th_percentile": 119.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 59.19, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.19, "10th_percentile": 59.19, "90th_percentile": 59.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 59.19, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.19, "10th_percentile": 59.19, "90th_percentile": 59.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 31.2, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.2, "10th_percentile": 34.0, "90th_percentile": 56.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 59.19, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.2, "10th_percentile": 34.0, "90th_percentile": 56.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 17.39, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.72, "10th_percentile": 17.66, "90th_percentile": 32.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 18.72, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.72, "10th_percentile": 17.66, "90th_percentile": 32.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 35.51, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.72, "10th_percentile": 17.66, "90th_percentile": 32.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 35.51, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 35.51, "10th_percentile": 35.51, "90th_percentile": 35.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 65.77, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 65.77, "10th_percentile": 65.77, "90th_percentile": 65.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 34.67, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 50.22, "10th_percentile": 37.78, "90th_percentile": 62.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 65.77, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 50.22, "10th_percentile": 37.78, "90th_percentile": 62.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 30.78, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 30.78, "10th_percentile": 30.78, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 76.29, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 76.29, "10th_percentile": 76.29, "90th_percentile": 76.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 92.07, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 92.07, "10th_percentile": 92.07, "90th_percentile": 92.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 27.74, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 27.74, "10th_percentile": 27.74, "90th_percentile": 27.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 27.74, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 27.74, "10th_percentile": 27.74, "90th_percentile": 27.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 24.48, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 24.48, "10th_percentile": 24.48, "90th_percentile": 24.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 56.86, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 56.86, "10th_percentile": 56.86, "90th_percentile": 56.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 20.8, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 20.8, "10th_percentile": 20.8, "90th_percentile": 20.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 34.67, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 34.67, "10th_percentile": 34.67, "90th_percentile": 34.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 40.43, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.43, "10th_percentile": 40.43, "90th_percentile": 40.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 22.19, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 22.19, "10th_percentile": 22.19, "90th_percentile": 22.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 44.93, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.93, "10th_percentile": 44.93, "90th_percentile": 44.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 40.29, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.29, "10th_percentile": 40.29, "90th_percentile": 40.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 13.45, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 13.45, "10th_percentile": 13.45, "90th_percentile": 13.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 69.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 69.34, "10th_percentile": 69.34, "90th_percentile": 69.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 58.94, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 58.94, "10th_percentile": 58.94, "90th_percentile": 58.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 45.07, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 45.07, "10th_percentile": 45.07, "90th_percentile": 45.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 55.47, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 55.47, "10th_percentile": 55.47, "90th_percentile": 55.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 69.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $69.34 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 69.34, "10th_percentile": 69.34, "90th_percentile": 69.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $69.34 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 69.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 69.34, "10th_percentile": 69.34, "90th_percentile": 69.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 16.16, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 16.16, "10th_percentile": 16.16, "90th_percentile": 16.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 55.47, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 55.47, "10th_percentile": 55.47, "90th_percentile": 55.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 69.34, "10th_percentile": 69.34, "90th_percentile": 69.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 69.34, "10th_percentile": 69.34, "90th_percentile": 69.34, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 69.34, "10th_percentile": 69.34, "90th_percentile": 69.34, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" } ] } ] }, { "description": "ADHESIVE SKIN AFFIX SURG TOPICAL .4 ML MSC091040Z - (DUP USE PS 381475)", "code_information": [ { "code": "SUP-347688", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 14.39, "maximum": 127.27, "setting": "outpatient", "gross_charge": 53.31, "discounted_cash": 37.32, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 53.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.29, "10th_percentile": 60.71, "90th_percentile": 119.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 127.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.29, "10th_percentile": 60.71, "90th_percentile": 119.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 53.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.29, "10th_percentile": 60.71, "90th_percentile": 119.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 127.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.29, "10th_percentile": 60.71, "90th_percentile": 119.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 53.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.29, "10th_percentile": 60.71, "90th_percentile": 119.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 127.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.29, "10th_percentile": 60.71, "90th_percentile": 119.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 53.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.29, "10th_percentile": 60.71, "90th_percentile": 119.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 127.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.29, "10th_percentile": 60.71, "90th_percentile": 119.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 127.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.29, "10th_percentile": 60.71, "90th_percentile": 119.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 53.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.29, "10th_percentile": 60.71, "90th_percentile": 119.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 53.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.29, "10th_percentile": 60.71, "90th_percentile": 119.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 127.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.29, "10th_percentile": 60.71, "90th_percentile": 119.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 127.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 127.27, "10th_percentile": 127.27, "90th_percentile": 127.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 53.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.29, "10th_percentile": 60.71, "90th_percentile": 119.87, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 127.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.29, "10th_percentile": 60.71, "90th_percentile": 119.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 53.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 90.29, "10th_percentile": 60.71, "90th_percentile": 119.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 127.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 90.29, "10th_percentile": 60.71, "90th_percentile": 119.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 57.27, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.27, "10th_percentile": 57.27, "90th_percentile": 57.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 57.27, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.27, "10th_percentile": 57.27, "90th_percentile": 57.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 57.27, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.27, "10th_percentile": 57.27, "90th_percentile": 57.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 14.39, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 24.38, "10th_percentile": 16.39, "90th_percentile": 32.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 34.36, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 24.38, "10th_percentile": 16.39, "90th_percentile": 32.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 34.36, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 34.36, "10th_percentile": 34.36, "90th_percentile": 34.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 63.64, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 63.64, "10th_percentile": 63.64, "90th_percentile": 63.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 63.64, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 63.64, "10th_percentile": 63.64, "90th_percentile": 63.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 29.78, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 29.78, "10th_percentile": 29.78, "90th_percentile": 29.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 73.82, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 73.82, "10th_percentile": 73.82, "90th_percentile": 73.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 89.09, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 89.09, "10th_percentile": 89.09, "90th_percentile": 89.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" } ] } ] }, { "description": "ADHESIVE SKNCLS 2 OCTYL CYNCRLT DRMBND V", "code_information": [ { "code": "SUP-347860", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 19.49, "maximum": 72.2, "setting": "outpatient", "gross_charge": 72.2, "discounted_cash": 50.54, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 72.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 72.2, "10th_percentile": 72.2, "90th_percentile": 72.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 72.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 72.2, "10th_percentile": 72.2, "90th_percentile": 72.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 72.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 72.2, "10th_percentile": 72.2, "90th_percentile": 72.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 72.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 72.2, "10th_percentile": 72.2, "90th_percentile": 72.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 72.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 72.2, "10th_percentile": 72.2, "90th_percentile": 72.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 72.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 72.2, "10th_percentile": 72.2, "90th_percentile": 72.2, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 72.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 72.2, "10th_percentile": 72.2, "90th_percentile": 72.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 72.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 72.2, "10th_percentile": 72.2, "90th_percentile": 72.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 19.49, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 19.49, "10th_percentile": 19.49, "90th_percentile": 19.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "ADHESIVE TOPICAL SKIN HISTOACRYL 0.5ML", "code_information": [ { "code": "SUP-360288", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 37.64, "maximum": 139.41, "setting": "outpatient", "gross_charge": 139.41, "discounted_cash": 97.59, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 139.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 139.41, "10th_percentile": 139.41, "90th_percentile": 139.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 139.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 139.41, "10th_percentile": 139.41, "90th_percentile": 139.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 139.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 139.41, "10th_percentile": 139.41, "90th_percentile": 139.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 139.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 139.41, "10th_percentile": 139.41, "90th_percentile": 139.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 139.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 139.41, "10th_percentile": 139.41, "90th_percentile": 139.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 139.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 139.41, "10th_percentile": 139.41, "90th_percentile": 139.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 139.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 139.41, "10th_percentile": 139.41, "90th_percentile": 139.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 139.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 139.41, "10th_percentile": 139.41, "90th_percentile": 139.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 37.64, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 37.64, "10th_percentile": 37.64, "90th_percentile": 37.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "ADMIRAL IN.PACT 6X250MMX130CM", "code_information": [ { "code": "SUP-334753", "type": "CDM" }, { "code": "C2623", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 1199.32, "maximum": 25607.45, "setting": "outpatient", "gross_charge": 14923.5, "discounted_cash": 10446.45, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 6715.58, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9468.7, "10th_percentile": 7541.52, "90th_percentile": 10906.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 9468.7, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9468.7, "10th_percentile": 7541.52, "90th_percentile": 10906.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 9468.7, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9468.7, "10th_percentile": 7541.52, "90th_percentile": 10906.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 11523.35, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9468.7, "10th_percentile": 7541.52, "90th_percentile": 10906.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 6715.58, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9468.7, "10th_percentile": 7541.52, "90th_percentile": 10906.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 9468.7, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9468.7, "10th_percentile": 7541.52, "90th_percentile": 10906.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 9468.7, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9468.7, "10th_percentile": 7541.52, "90th_percentile": 10906.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 11523.35, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9468.7, "10th_percentile": 7541.52, "90th_percentile": 10906.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 6715.58, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9468.7, "10th_percentile": 6944.66, "90th_percentile": 10701.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 7288.27, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9468.7, "10th_percentile": 6944.66, "90th_percentile": 10701.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 9468.7, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9468.7, "10th_percentile": 6944.66, "90th_percentile": 10701.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 9468.7, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9468.7, "10th_percentile": 6944.66, "90th_percentile": 10701.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 11523.35, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9468.7, "10th_percentile": 6944.66, "90th_percentile": 10701.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1383.83, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5681.22, "10th_percentile": 2442.04, "90th_percentile": 6420.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 4029.35, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5681.22, "10th_percentile": 2442.04, "90th_percentile": 6420.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 5681.22, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5681.22, "10th_percentile": 2442.04, "90th_percentile": 6420.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 5681.22, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5681.22, "10th_percentile": 2442.04, "90th_percentile": 6420.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 6914.01, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5681.22, "10th_percentile": 2442.04, "90th_percentile": 6420.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 6914.01, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4372.96, "10th_percentile": 2041.66, "90th_percentile": 6174.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 5681.22, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4372.96, "10th_percentile": 2041.66, "90th_percentile": 6174.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 5681.22, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4372.96, "10th_percentile": 2041.66, "90th_percentile": 6174.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 4372.96, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4372.96, "10th_percentile": 2041.66, "90th_percentile": 6174.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 4029.35, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4372.96, "10th_percentile": 2041.66, "90th_percentile": 6174.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2480.21, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4372.96, "10th_percentile": 2041.66, "90th_percentile": 6174.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1383.83, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4372.96, "10th_percentile": 2041.66, "90th_percentile": 6174.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 7461.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 10520.78, "10th_percentile": 8379.46, "90th_percentile": 12118.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 10520.78, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 10520.78, "10th_percentile": 8379.46, "90th_percentile": 12118.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 10520.78, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 10520.78, "10th_percentile": 8379.46, "90th_percentile": 12118.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 12803.73, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 10520.78, "10th_percentile": 8379.46, "90th_percentile": 12118.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 12803.73, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 10520.78, "10th_percentile": 7716.28, "90th_percentile": 11890.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 10520.78, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 10520.78, "10th_percentile": 7716.28, "90th_percentile": 11890.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 10520.78, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 10520.78, "10th_percentile": 7716.28, "90th_percentile": 11890.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 8098.08, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 10520.78, "10th_percentile": 7716.28, "90th_percentile": 11890.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 7461.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 10520.78, "10th_percentile": 7716.28, "90th_percentile": 11890.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1199.32, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 4923.72, "10th_percentile": 2116.43, "90th_percentile": 5564.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 3492.1, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 4923.72, "10th_percentile": 2116.43, "90th_percentile": 5564.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 4923.72, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 4923.72, "10th_percentile": 2116.43, "90th_percentile": 5564.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 4923.72, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 4923.72, "10th_percentile": 2116.43, "90th_percentile": 5564.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 5992.14, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 4923.72, "10th_percentile": 2116.43, "90th_percentile": 5564.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 8655.63, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 12204.1, "10th_percentile": 9720.17, "90th_percentile": 14057.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 12204.1, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 12204.1, "10th_percentile": 9720.17, "90th_percentile": 14057.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 12204.1, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 12204.1, "10th_percentile": 9720.17, "90th_percentile": 14057.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 14852.32, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 12204.1, "10th_percentile": 9720.17, "90th_percentile": 14057.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 10446.45, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 14729.09, "10th_percentile": 11731.24, "90th_percentile": 16966.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 14729.09, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 14729.09, "10th_percentile": 11731.24, "90th_percentile": 16966.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 14729.09, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 14729.09, "10th_percentile": 11731.24, "90th_percentile": 16966.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 17925.22, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 14729.09, "10th_percentile": 11731.24, "90th_percentile": 16966.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 9185.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 18618.85, "10th_percentile": 12054.73, "90th_percentile": 23324.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 14923.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 18618.85, "10th_percentile": 12054.73, "90th_percentile": 23324.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 16196.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 18618.85, "10th_percentile": 12054.73, "90th_percentile": 23324.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 21041.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 18618.85, "10th_percentile": 12054.73, "90th_percentile": 23324.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 21041.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 18618.85, "10th_percentile": 12054.73, "90th_percentile": 23324.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 25607.45, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 18618.85, "10th_percentile": 12054.73, "90th_percentile": 23324.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 25607.45, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 21041.55, "10th_percentile": 11480.97, "90th_percentile": 23781.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 21041.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 21041.55, "10th_percentile": 11480.97, "90th_percentile": 23781.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 21041.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 21041.55, "10th_percentile": 11480.97, "90th_percentile": 23781.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14923.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 21041.55, "10th_percentile": 11480.97, "90th_percentile": 23781.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9185.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 21041.55, "10th_percentile": 11480.97, "90th_percentile": 23781.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14923.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 21041.55, "10th_percentile": 16758.92, "90th_percentile": 24237.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 21041.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 21041.55, "10th_percentile": 16758.92, "90th_percentile": 24237.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 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100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 25607.45, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18618.85, "10th_percentile": 12054.73, "90th_percentile": 23324.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9185.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18618.85, "10th_percentile": 12054.73, "90th_percentile": 23324.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14923.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 25607.45, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18618.85, "10th_percentile": 12054.73, "90th_percentile": 23324.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 16196.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18618.85, "10th_percentile": 12054.73, "90th_percentile": 23324.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14923.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 16196.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18618.85, "10th_percentile": 12054.73, "90th_percentile": 23324.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14923.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18618.85, "10th_percentile": 12054.73, "90th_percentile": 23324.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9185.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18618.85, "10th_percentile": 12054.73, "90th_percentile": 23324.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 16196.16, "10th_percentile": 16196.16, "90th_percentile": 16196.16, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 16196.16, "10th_percentile": 16196.16, "90th_percentile": 16196.16, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 16196.16, "10th_percentile": 16196.16, "90th_percentile": 16196.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 10495.11, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10495.11, "10th_percentile": 10495.11, "90th_percentile": 10495.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 9409.97, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7346.56, "10th_percentile": 7346.56, "90th_percentile": 7346.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 16196.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $16,196.16 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 16196.16, "10th_percentile": 16196.16, "90th_percentile": 16196.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $16,196.16 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 3773.71, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3773.71, "10th_percentile": 3773.71, "90th_percentile": 3773.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 12956.93, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 12956.93, "10th_percentile": 12956.93, "90th_percentile": 12956.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 8098.08, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 8098.08, "10th_percentile": 8098.08, "90th_percentile": 8098.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 9442.36, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9442.36, "10th_percentile": 9442.36, "90th_percentile": 9442.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMH PHCS PPO", "standard_charge_dollar": 12956.93, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 12956.93, "10th_percentile": 12956.93, "90th_percentile": 12956.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 16196.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 16196.16, "10th_percentile": 16196.16, "90th_percentile": 16196.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 10527.5, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 10527.5, "10th_percentile": 10527.5, "90th_percentile": 10527.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 13280.85, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 13280.85, "10th_percentile": 13280.85, "90th_percentile": 13280.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 13766.74, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 13766.74, "10th_percentile": 13766.74, "90th_percentile": 13766.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 5182.77, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5182.77, "10th_percentile": 5182.77, "90th_percentile": 5182.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 5717.24, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 5717.24, "10th_percentile": 5717.24, "90th_percentile": 5717.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 4858.85, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 4858.85, "10th_percentile": 4858.85, "90th_percentile": 4858.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 3142.06, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 3142.06, "10th_percentile": 3142.06, "90th_percentile": 3142.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 6478.46, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 6478.46, "10th_percentile": 6478.46, "90th_percentile": 6478.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 6478.46, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 6478.46, "10th_percentile": 6478.46, "90th_percentile": 6478.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 16196.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 16196.16, "10th_percentile": 16196.16, "90th_percentile": 16196.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "ADPT FEM OFST REV 3MM", "code_information": [ { "code": "SUP-143568", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1569.44, "maximum": 14307.13, "setting": "outpatient", "gross_charge": 7511.88, "discounted_cash": 5258.32, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2028.21, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2184.27, "10th_percentile": 2059.42, "90th_percentile": 3527.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2184.27, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2184.27, "10th_percentile": 2059.42, "90th_percentile": 3527.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3862.93, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2184.27, "10th_percentile": 2059.42, "90th_percentile": 3527.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3862.93, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3862.93, "10th_percentile": 3862.93, "90th_percentile": 3862.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 8298.14, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 8298.14, "10th_percentile": 8298.14, "90th_percentile": 8298.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 10014.99, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 10014.99, "10th_percentile": 10014.99, "90th_percentile": 10014.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 3347.87, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 3347.87, "10th_percentile": 3347.87, "90th_percentile": 3347.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 7153.57, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 7153.57, "10th_percentile": 7153.57, "90th_percentile": 7153.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 7153.57, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 5599.26, "10th_percentile": 4355.81, "90th_percentile": 6842.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 4044.95, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 5599.26, "10th_percentile": 4355.81, "90th_percentile": 6842.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 6438.21, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6438.21, "10th_percentile": 6438.21, "90th_percentile": 6438.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 6438.21, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6438.21, "10th_percentile": 6438.21, "90th_percentile": 6438.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3640.46, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5039.34, "10th_percentile": 3920.24, "90th_percentile": 6158.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 6438.21, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5039.34, "10th_percentile": 3920.24, "90th_percentile": 6158.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 8089.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 8089.9, "10th_percentile": 7627.48, "90th_percentile": 13063.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 7511.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 8089.9, "10th_percentile": 7627.48, "90th_percentile": 13063.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 14307.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 8089.9, "10th_percentile": 7627.48, "90th_percentile": 13063.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14307.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14307.13, "10th_percentile": 14307.13, "90th_percentile": 14307.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7511.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10909.5, "10th_percentile": 8191.41, "90th_percentile": 13627.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14307.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10909.5, "10th_percentile": 8191.41, "90th_percentile": 13627.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8089.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8089.9, "10th_percentile": 7627.48, "90th_percentile": 13063.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7511.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8089.9, "10th_percentile": 7627.48, "90th_percentile": 13063.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14307.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8089.9, "10th_percentile": 7627.48, "90th_percentile": 13063.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8089.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8089.9, "10th_percentile": 7627.48, "90th_percentile": 13063.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7511.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8089.9, "10th_percentile": 7627.48, "90th_percentile": 13063.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14307.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8089.9, "10th_percentile": 7627.48, "90th_percentile": 13063.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8089.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8089.9, "10th_percentile": 7627.48, "90th_percentile": 13063.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7511.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8089.9, "10th_percentile": 7627.48, "90th_percentile": 13063.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14307.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8089.9, "10th_percentile": 7627.48, "90th_percentile": 13063.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14307.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8089.9, "10th_percentile": 7627.48, "90th_percentile": 13063.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8089.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8089.9, "10th_percentile": 7627.48, "90th_percentile": 13063.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7511.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8089.9, "10th_percentile": 7627.48, "90th_percentile": 13063.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8089.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8089.9, "10th_percentile": 7627.48, "90th_percentile": 13063.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7511.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8089.9, "10th_percentile": 7627.48, "90th_percentile": 13063.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14307.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8089.9, "10th_percentile": 7627.48, "90th_percentile": 13063.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8089.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8089.9, "10th_percentile": 7627.48, "90th_percentile": 13063.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7511.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8089.9, "10th_percentile": 7627.48, "90th_percentile": 13063.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 14307.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8089.9, "10th_percentile": 7627.48, "90th_percentile": 13063.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 5242.26, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2464.5, "10th_percentile": 2464.5, "90th_percentile": 2464.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 4700.23, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2143.36, "10th_percentile": 2143.36, "90th_percentile": 2143.36, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 1884.95, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 915.61, "10th_percentile": 915.61, "90th_percentile": 915.61, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 1569.44, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 1051.1, "10th_percentile": 1051.1, "90th_percentile": 1051.1, "count": "12", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 3235.96, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 3235.96, "10th_percentile": 3235.96, "90th_percentile": 3235.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 3235.96, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 3235.96, "10th_percentile": 3235.96, "90th_percentile": 3235.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 2426.97, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 1290.36, "10th_percentile": 1290.36, "90th_percentile": 1290.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 2855.73, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 2855.73, "10th_percentile": 2855.73, "90th_percentile": 2855.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 6876.42, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 6876.42, "10th_percentile": 6876.42, "90th_percentile": 6876.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 6471.92, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 6471.92, "10th_percentile": 6471.92, "90th_percentile": 6471.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 5258.44, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 5258.44, "10th_percentile": 5258.44, "90th_percentile": 5258.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 6471.92, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 6471.92, "10th_percentile": 6471.92, "90th_percentile": 6471.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 2588.77, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2588.77, "10th_percentile": 2588.77, "90th_percentile": 2588.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 6633.72, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 6633.72, "10th_percentile": 6633.72, "90th_percentile": 6633.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 8089.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $8,089.90 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 8089.9, "10th_percentile": 8089.9, "90th_percentile": 8089.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $8,089.90 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 8089.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8089.9, "10th_percentile": 8089.9, "90th_percentile": 8089.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 8089.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 8089.9, "10th_percentile": 8089.9, "90th_percentile": 8089.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 4716.41, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4716.41, "10th_percentile": 4716.41, "90th_percentile": 4716.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 4044.95, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 4044.95, "10th_percentile": 4044.95, "90th_percentile": 4044.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 8089.9, "10th_percentile": 8089.9, "90th_percentile": 8089.9, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 8089.9, "10th_percentile": 8089.9, "90th_percentile": 8089.9, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 8089.9, "10th_percentile": 8089.9, "90th_percentile": 8089.9, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ADPT HEAD FEM ENDOPROS VERSYS +10.5MM TIV", "code_information": [ { "code": "SUP-349723", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 89.68, "maximum": 876.86, "setting": "outpatient", "gross_charge": 429.25, "discounted_cash": 300.47, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 429.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 462.28, "10th_percentile": 435.86, "90th_percentile": 793.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 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100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 876.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 462.28, "10th_percentile": 435.86, "90th_percentile": 793.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 429.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 462.28, "10th_percentile": 435.86, "90th_percentile": 793.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 462.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 462.28, "10th_percentile": 435.86, "90th_percentile": 793.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 876.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 462.28, "10th_percentile": 435.86, "90th_percentile": 793.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 876.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 876.86, "10th_percentile": 876.86, "90th_percentile": 876.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 429.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 653.06, "10th_percentile": 474.01, "90th_percentile": 832.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 876.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 653.06, "10th_percentile": 474.01, "90th_percentile": 832.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 876.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 462.28, "10th_percentile": 435.86, "90th_percentile": 793.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 462.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 462.28, "10th_percentile": 435.86, "90th_percentile": 793.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 429.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 462.28, "10th_percentile": 435.86, "90th_percentile": 793.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 429.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 462.28, "10th_percentile": 435.86, "90th_percentile": 793.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 462.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 462.28, "10th_percentile": 435.86, "90th_percentile": 793.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 876.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 462.28, "10th_percentile": 435.86, "90th_percentile": 793.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 394.59, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 394.59, "10th_percentile": 394.59, "90th_percentile": 394.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 394.59, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 394.59, "10th_percentile": 394.59, "90th_percentile": 394.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 208.03, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 301.31, "10th_percentile": 226.69, "90th_percentile": 375.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 394.59, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 301.31, "10th_percentile": 226.69, "90th_percentile": 375.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 236.75, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 236.75, "10th_percentile": 236.75, "90th_percentile": 236.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 115.9, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 124.82, "10th_percentile": 117.68, "90th_percentile": 214.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 124.82, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 124.82, "10th_percentile": 117.68, "90th_percentile": 214.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 236.75, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 124.82, "10th_percentile": 117.68, "90th_percentile": 214.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 438.43, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 334.78, "10th_percentile": 251.87, "90th_percentile": 417.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 231.14, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 334.78, "10th_percentile": 251.87, "90th_percentile": 417.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 438.43, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 438.43, "10th_percentile": 438.43, "90th_percentile": 438.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 205.19, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 205.19, "10th_percentile": 205.19, "90th_percentile": 205.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 613.8, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 613.8, "10th_percentile": 613.8, "90th_percentile": 613.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 508.58, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 508.58, "10th_percentile": 508.58, "90th_percentile": 508.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 299.56, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2464.5, "10th_percentile": 2464.5, "90th_percentile": 2464.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 268.58, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2143.36, "10th_percentile": 2143.36, "90th_percentile": 2143.36, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 107.71, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 915.61, "10th_percentile": 915.61, "90th_percentile": 915.61, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 89.68, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 1051.1, "10th_percentile": 1051.1, "90th_percentile": 1051.1, "count": "12", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 184.91, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 184.91, "10th_percentile": 184.91, "90th_percentile": 184.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 184.91, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 184.91, "10th_percentile": 184.91, "90th_percentile": 184.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 138.68, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 1290.36, "10th_percentile": 1290.36, "90th_percentile": 1290.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 163.18, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 163.18, "10th_percentile": 163.18, "90th_percentile": 163.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 392.94, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 392.94, "10th_percentile": 392.94, "90th_percentile": 392.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 369.82, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 369.82, "10th_percentile": 369.82, "90th_percentile": 369.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 300.48, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 300.48, "10th_percentile": 300.48, "90th_percentile": 300.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 369.82, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 369.82, "10th_percentile": 369.82, "90th_percentile": 369.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 147.93, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 147.93, "10th_percentile": 147.93, "90th_percentile": 147.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 379.07, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 379.07, "10th_percentile": 379.07, "90th_percentile": 379.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 462.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $462.28 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 462.28, "10th_percentile": 462.28, "90th_percentile": 462.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $462.28 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 462.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 462.28, "10th_percentile": 462.28, "90th_percentile": 462.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 269.51, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 269.51, "10th_percentile": 269.51, "90th_percentile": 269.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 231.14, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 462.28, "10th_percentile": 462.28, "90th_percentile": 462.28, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 462.28, "10th_percentile": 462.28, "90th_percentile": 462.28, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 462.28, "10th_percentile": 462.28, "90th_percentile": 462.28, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 462.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 462.28, "10th_percentile": 462.28, "90th_percentile": 462.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "ADPT HUM HD 7DIAX170LG RVRS FX HMROPRSTHS AEQ", "code_information": [ { "code": "SUP-314004", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1678.69, "maximum": 24552.08, "setting": "outpatient", "gross_charge": 24552.08, "discounted_cash": 17186.46, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 6629.06, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4283.01, "10th_percentile": 2406.16, "90th_percentile": 6159.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1936.95, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4283.01, "10th_percentile": 2406.16, "90th_percentile": 6159.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1936.95, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4283.01, "10th_percentile": 2406.16, "90th_percentile": 6159.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 6629.06, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4283.01, "10th_percentile": 2406.16, "90th_percentile": 6159.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 14240.21, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 14240.21, "10th_percentile": 14240.21, "90th_percentile": 14240.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 17186.46, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 17186.46, "10th_percentile": 17186.46, "90th_percentile": 17186.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 5745.19, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 3711.94, "10th_percentile": 2085.34, "90th_percentile": 5338.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1678.69, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 3711.94, "10th_percentile": 2085.34, "90th_percentile": 5338.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 12276.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 12276.04, "10th_percentile": 12276.04, "90th_percentile": 12276.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 12276.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 12276.04, "10th_percentile": 12276.04, "90th_percentile": 12276.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 11048.44, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11048.44, "10th_percentile": 11048.44, "90th_percentile": 11048.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 11048.44, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11048.44, "10th_percentile": 11048.44, "90th_percentile": 11048.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 11048.44, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11048.44, "10th_percentile": 11048.44, "90th_percentile": 11048.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 24552.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 24552.08, "10th_percentile": 24552.08, "90th_percentile": 24552.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 24552.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 24552.08, "10th_percentile": 24552.08, "90th_percentile": 24552.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 24552.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 24552.08, "10th_percentile": 24552.08, "90th_percentile": 24552.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 24552.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 24552.08, "10th_percentile": 24552.08, "90th_percentile": 24552.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 24552.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 24552.08, "10th_percentile": 24552.08, "90th_percentile": 24552.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 24552.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 24552.08, "10th_percentile": 24552.08, "90th_percentile": 24552.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 24552.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 24552.08, "10th_percentile": 24552.08, "90th_percentile": 24552.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 24552.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 24552.08, "10th_percentile": 24552.08, "90th_percentile": 24552.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 24552.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 24552.08, "10th_percentile": 24552.08, "90th_percentile": 24552.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "ADPT IV ANGIO AIRLSS ROT M TO", "code_information": [ { "code": "SUP-306785", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 1.75, "maximum": 23.33, "setting": "outpatient", "gross_charge": 23.33, "discounted_cash": 16.33, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 23.33, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 19.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 19.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 23.33, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 23.33, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 19.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 23.33, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18.14, "10th_percentile": 14.65, "90th_percentile": 22.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 19.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18.14, "10th_percentile": 14.65, "90th_percentile": 22.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18.14, "10th_percentile": 14.65, "90th_percentile": 22.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18.14, "10th_percentile": 14.65, "90th_percentile": 22.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 17.1, "10th_percentile": 10.46, "90th_percentile": 21.67, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 17.1, "10th_percentile": 10.46, "90th_percentile": 21.67, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 17.1, "10th_percentile": 10.46, "90th_percentile": 21.67, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 19.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 17.1, "10th_percentile": 10.46, "90th_percentile": 21.67, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 23.33, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 17.1, "10th_percentile": 10.46, "90th_percentile": 21.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 8.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 9.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 13.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 17.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 19.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 23.33, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 15.35, "10th_percentile": 8.69, "90th_percentile": 21.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 6.12, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.17, "10th_percentile": 6.59, "90th_percentile": 9.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 7.7, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.17, "10th_percentile": 6.59, "90th_percentile": 9.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 8.63, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.17, "10th_percentile": 6.59, "90th_percentile": 9.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 10.5, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.17, "10th_percentile": 6.59, "90th_percentile": 9.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 6.12, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.17, "10th_percentile": 6.59, "90th_percentile": 9.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 7.7, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.17, "10th_percentile": 6.59, "90th_percentile": 9.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 8.63, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.17, "10th_percentile": 6.59, "90th_percentile": 9.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 10.5, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.17, "10th_percentile": 6.59, "90th_percentile": 9.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 10.5, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.7, "10th_percentile": 4.88, "90th_percentile": 9.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 8.63, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.7, "10th_percentile": 4.88, "90th_percentile": 9.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 7.7, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.7, "10th_percentile": 4.88, "90th_percentile": 9.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 6.12, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.7, "10th_percentile": 4.88, "90th_percentile": 9.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 4.05, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.7, "10th_percentile": 4.88, "90th_percentile": 9.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2.26, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.14, "10th_percentile": 2.34, "90th_percentile": 5.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2.43, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.14, "10th_percentile": 2.34, "90th_percentile": 5.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3.67, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.14, "10th_percentile": 2.34, "90th_percentile": 5.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 4.62, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.14, "10th_percentile": 2.34, "90th_percentile": 5.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 5.18, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.14, "10th_percentile": 2.34, "90th_percentile": 5.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 6.3, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.14, "10th_percentile": 2.34, "90th_percentile": 5.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3.67, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.9, "10th_percentile": 3.96, "90th_percentile": 5.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 4.62, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.9, "10th_percentile": 3.96, "90th_percentile": 5.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 5.18, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.9, "10th_percentile": 3.96, "90th_percentile": 5.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 6.3, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.9, "10th_percentile": 3.96, "90th_percentile": 5.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 6.8, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 9.07, "10th_percentile": 7.33, "90th_percentile": 11.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 8.55, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 9.07, "10th_percentile": 7.33, "90th_percentile": 11.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 9.59, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 9.07, "10th_percentile": 7.33, "90th_percentile": 11.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 11.67, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 9.07, "10th_percentile": 7.33, "90th_percentile": 11.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 4.51, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 8.55, "10th_percentile": 5.43, "90th_percentile": 10.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 6.8, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 8.55, "10th_percentile": 5.43, "90th_percentile": 10.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 8.55, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 8.55, "10th_percentile": 5.43, "90th_percentile": 10.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 9.59, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 8.55, "10th_percentile": 5.43, "90th_percentile": 10.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 11.67, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 8.55, "10th_percentile": 5.43, "90th_percentile": 10.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 3.18, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 4.25, "10th_percentile": 3.43, "90th_percentile": 5.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 4.0, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 4.25, "10th_percentile": 3.43, "90th_percentile": 5.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 4.49, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 4.25, "10th_percentile": 3.43, "90th_percentile": 5.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 5.46, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 4.25, "10th_percentile": 3.43, "90th_percentile": 5.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 13.53, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 10.52, "10th_percentile": 8.5, "90th_percentile": 12.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 11.12, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 10.52, "10th_percentile": 8.5, "90th_percentile": 12.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 9.92, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 10.52, "10th_percentile": 8.5, "90th_percentile": 12.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 7.89, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 10.52, "10th_percentile": 8.5, "90th_percentile": 12.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 9.52, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 12.7, "10th_percentile": 10.26, "90th_percentile": 15.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 11.97, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 12.7, "10th_percentile": 10.26, "90th_percentile": 15.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 13.42, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 12.7, "10th_percentile": 10.26, "90th_percentile": 15.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 16.33, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 12.7, "10th_percentile": 10.26, "90th_percentile": 15.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 3.6, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% 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 Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 3.6, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% 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 Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 3.18, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 3.18, "10th_percentile": 3.18, "90th_percentile": 3.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 7.39, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 7.39, "10th_percentile": 7.39, "90th_percentile": 7.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 2.7, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% 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 OP Services; 30% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 4.51, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 4.51, "10th_percentile": 4.51, "90th_percentile": 4.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 5.25, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 2.88, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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 Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 5.84, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.84, "10th_percentile": 5.84, "90th_percentile": 5.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 5.23, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.23, "10th_percentile": 5.23, "90th_percentile": 5.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.75, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% 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 Services; 19.4% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 9.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 9.01, "10th_percentile": 9.01, "90th_percentile": 9.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 7.66, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 7.66, "10th_percentile": 7.66, "90th_percentile": 7.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 5.86, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 5.86, "10th_percentile": 5.86, "90th_percentile": 5.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 7.21, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% 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; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 9.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $9.01 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 9.01, "10th_percentile": 9.01, "90th_percentile": 9.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $9.01 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9.01, "10th_percentile": 9.01, "90th_percentile": 9.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 2.1, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.1, "10th_percentile": 2.1, "90th_percentile": 2.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 7.21, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 7.21, "10th_percentile": 7.21, "90th_percentile": 7.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 9.01, "10th_percentile": 9.01, "90th_percentile": 9.01, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 9.01, "10th_percentile": 9.01, "90th_percentile": 9.01, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 9.01, "10th_percentile": 9.01, "90th_percentile": 9.01, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" } ] } ] }, { "description": "ADPT OFST DURAC STD 4MM COCR", "code_information": [ { "code": "SUP-1649", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 521.23, "maximum": 8453.23, "setting": "outpatient", "gross_charge": 2227.49, "discounted_cash": 1559.24, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 601.42, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1085.15, "10th_percentile": 752.16, "90th_percentile": 2192.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 978.27, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1085.15, "10th_percentile": 752.16, "90th_percentile": 2192.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1085.15, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1085.15, "10th_percentile": 752.16, "90th_percentile": 2192.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2058.32, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1085.15, "10th_percentile": 752.16, "90th_percentile": 2192.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2282.37, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1085.15, "10th_percentile": 752.16, "90th_percentile": 2192.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2282.37, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2058.32, "10th_percentile": 892.8, "90th_percentile": 2237.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2058.32, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2058.32, "10th_percentile": 892.8, "90th_percentile": 2237.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 601.42, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2058.32, "10th_percentile": 892.8, "90th_percentile": 2237.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC SEIU HEALTHLINK", "standard_charge_dollar": 4649.28, "standard_charge_percentage": 55.0, "standard_charge_algorithm": "All Services; 55% Billed", "median_amount": 4649.28, "10th_percentile": 4649.28, "90th_percentile": 4649.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 55% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 4421.58, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 4662.23, "10th_percentile": 4469.71, "90th_percentile": 4854.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 4902.87, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 4662.23, "10th_percentile": 4469.71, "90th_percentile": 4854.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 5336.39, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 5626.83, "10th_percentile": 5394.48, "90th_percentile": 5859.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 5917.26, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 5626.83, "10th_percentile": 5394.48, "90th_percentile": 5859.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 521.23, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1880.97, "10th_percentile": 900.03, "90th_percentile": 1978.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1783.88, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1880.97, "10th_percentile": 900.03, "90th_percentile": 1978.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1978.06, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1880.97, "10th_percentile": 900.03, "90th_percentile": 1978.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1978.06, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1880.97, "10th_percentile": 900.03, "90th_percentile": 1978.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3811.71, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 4019.16, "10th_percentile": 3853.2, "90th_percentile": 4185.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 4226.62, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 4019.16, "10th_percentile": 3853.2, "90th_percentile": 4185.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2009.53, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3811.71, "10th_percentile": 2369.97, "90th_percentile": 4143.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3811.71, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3811.71, "10th_percentile": 2369.97, "90th_percentile": 4143.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 4226.62, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3811.71, "10th_percentile": 2369.97, "90th_percentile": 4143.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 3430.54, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3617.24, "10th_percentile": 3467.88, "90th_percentile": 3766.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 3803.95, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3617.24, "10th_percentile": 3467.88, "90th_percentile": 3766.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3430.54, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3617.24, "10th_percentile": 3467.88, "90th_percentile": 3766.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3803.95, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3617.24, "10th_percentile": 3467.88, "90th_percentile": 3766.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1808.58, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3430.54, "10th_percentile": 2132.97, "90th_percentile": 3729.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3430.54, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3430.54, "10th_percentile": 2132.97, "90th_percentile": 3729.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3803.95, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3430.54, "10th_percentile": 2132.97, "90th_percentile": 3729.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 8453.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 4019.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 3623.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8453.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8038.32, "10th_percentile": 7706.4, "90th_percentile": 8370.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8038.32, "10th_percentile": 7706.4, "90th_percentile": 8370.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8453.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7623.42, "10th_percentile": 4423.26, "90th_percentile": 8287.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7623.42, "10th_percentile": 4423.26, "90th_percentile": 8287.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3623.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7623.42, "10th_percentile": 4423.26, "90th_percentile": 8287.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8453.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4019.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3623.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3623.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4019.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8453.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3623.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4019.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8453.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3623.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4019.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8453.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3623.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4019.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8453.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3623.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4019.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8453.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5821.24, "10th_percentile": 3741.97, "90th_percentile": 8204.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 2604.35, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2464.5, "10th_percentile": 2464.5, "90th_percentile": 2464.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 2335.07, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2143.36, "10th_percentile": 2143.36, "90th_percentile": 2143.36, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 936.44, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 915.61, "10th_percentile": 915.61, "90th_percentile": 915.61, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 779.7, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 1051.1, "10th_percentile": 1051.1, "90th_percentile": 1051.1, "count": "12", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 1607.62, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 1607.62, "10th_percentile": 1607.62, "90th_percentile": 1607.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 1607.62, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 1607.62, "10th_percentile": 1607.62, "90th_percentile": 1607.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 1205.72, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 1290.36, "10th_percentile": 1290.36, "90th_percentile": 1290.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 1418.73, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 1418.73, "10th_percentile": 1418.73, "90th_percentile": 1418.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 3416.2, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 3416.2, "10th_percentile": 3416.2, "90th_percentile": 3416.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 3215.25, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 3215.25, "10th_percentile": 3215.25, "90th_percentile": 3215.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2612.39, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 2612.39, "10th_percentile": 2612.39, "90th_percentile": 2612.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 3215.25, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3215.25, "10th_percentile": 3215.25, "90th_percentile": 3215.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 1286.1, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1286.1, "10th_percentile": 1286.1, "90th_percentile": 1286.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 3295.63, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 3295.63, "10th_percentile": 3295.63, "90th_percentile": 3295.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 4019.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $4,019.06 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 4019.06, "10th_percentile": 4019.06, "90th_percentile": 4019.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $4,019.06 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4019.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4019.06, "10th_percentile": 4019.06, "90th_percentile": 4019.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 4019.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 4019.06, "10th_percentile": 4019.06, "90th_percentile": 4019.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 2343.11, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2343.11, "10th_percentile": 2343.11, "90th_percentile": 2343.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 2009.53, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2009.53, "10th_percentile": 2009.53, "90th_percentile": 2009.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 4019.06, "10th_percentile": 4019.06, "90th_percentile": 4019.06, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 4019.06, "10th_percentile": 4019.06, "90th_percentile": 4019.06, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4019.06, "10th_percentile": 4019.06, "90th_percentile": 4019.06, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ADPT OFST DURAC STD 6MM COCR", "code_information": [ { "code": "SUP-58294", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 521.23, "maximum": 7623.42, "setting": "outpatient", "gross_charge": 3731.9, "discounted_cash": 2612.33, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3731.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4019.06, "10th_percentile": 3789.33, "90th_percentile": 6902.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4019.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4019.06, "10th_percentile": 3789.33, "90th_percentile": 6902.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4019.06, "10th_percentile": 3789.33, "90th_percentile": 6902.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4019.06, "10th_percentile": 3789.33, "90th_percentile": 6902.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4019.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4019.06, "10th_percentile": 3789.33, "90th_percentile": 6902.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3731.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4019.06, "10th_percentile": 3789.33, "90th_percentile": 6902.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3731.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4019.06, "10th_percentile": 3789.33, "90th_percentile": 6902.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4019.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4019.06, "10th_percentile": 3789.33, "90th_percentile": 6902.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4019.06, "10th_percentile": 3789.33, "90th_percentile": 6902.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3731.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4019.06, "10th_percentile": 3789.33, "90th_percentile": 6902.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4019.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4019.06, "10th_percentile": 3789.33, "90th_percentile": 6902.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4019.06, "10th_percentile": 3789.33, "90th_percentile": 6902.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3731.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4019.06, "10th_percentile": 3789.33, "90th_percentile": 6902.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4019.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4019.06, "10th_percentile": 3789.33, "90th_percentile": 6902.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4019.06, "10th_percentile": 3789.33, "90th_percentile": 6902.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7623.42, "10th_percentile": 7623.42, "90th_percentile": 7623.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3731.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5677.66, "10th_percentile": 4121.05, "90th_percentile": 7234.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5677.66, "10th_percentile": 4121.05, "90th_percentile": 7234.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4019.06, "10th_percentile": 3789.33, "90th_percentile": 6902.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4019.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4019.06, "10th_percentile": 3789.33, "90th_percentile": 6902.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3731.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4019.06, "10th_percentile": 3789.33, "90th_percentile": 6902.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 3731.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 4019.06, "10th_percentile": 3789.33, "90th_percentile": 6902.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 4019.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 4019.06, "10th_percentile": 3789.33, "90th_percentile": 6902.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 4019.06, "10th_percentile": 3789.33, "90th_percentile": 6902.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 3430.54, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3430.54, "10th_percentile": 3430.54, "90th_percentile": 3430.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3430.54, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3430.54, "10th_percentile": 3430.54, "90th_percentile": 3430.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1808.58, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2619.56, "10th_percentile": 1970.78, "90th_percentile": 3268.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3430.54, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2619.56, "10th_percentile": 1970.78, "90th_percentile": 3268.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 601.42, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1329.87, "10th_percentile": 747.11, "90th_percentile": 1912.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2058.32, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1329.87, "10th_percentile": 747.11, "90th_percentile": 1912.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 601.42, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1046.38, "10th_percentile": 723.28, "90th_percentile": 1766.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1007.61, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1046.38, "10th_percentile": 723.28, "90th_percentile": 1766.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1085.15, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1046.38, "10th_percentile": 723.28, "90th_percentile": 1766.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2058.32, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1046.38, "10th_percentile": 723.28, "90th_percentile": 1766.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3811.71, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2910.62, "10th_percentile": 2189.75, "90th_percentile": 3631.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2009.53, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2910.62, "10th_percentile": 2189.75, "90th_percentile": 3631.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3811.71, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3811.71, "10th_percentile": 3811.71, "90th_percentile": 3811.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 521.23, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1152.56, "10th_percentile": 647.5, "90th_percentile": 1657.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1783.88, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1152.56, "10th_percentile": 647.5, "90th_percentile": 1657.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 5336.39, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 5336.39, "10th_percentile": 5336.39, "90th_percentile": 5336.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 4421.58, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 4421.58, "10th_percentile": 4421.58, "90th_percentile": 4421.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 2604.35, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2464.5, "10th_percentile": 2464.5, "90th_percentile": 2464.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 2335.07, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2143.36, "10th_percentile": 2143.36, "90th_percentile": 2143.36, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 936.44, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 915.61, "10th_percentile": 915.61, "90th_percentile": 915.61, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 779.7, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 1051.1, "10th_percentile": 1051.1, "90th_percentile": 1051.1, "count": "12", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 1607.62, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 1607.62, "10th_percentile": 1607.62, "90th_percentile": 1607.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 1607.62, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 1607.62, "10th_percentile": 1607.62, "90th_percentile": 1607.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 1205.72, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 1290.36, "10th_percentile": 1290.36, "90th_percentile": 1290.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 1418.73, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 1418.73, "10th_percentile": 1418.73, "90th_percentile": 1418.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 3416.2, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 3416.2, "10th_percentile": 3416.2, "90th_percentile": 3416.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 3215.25, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 3215.25, "10th_percentile": 3215.25, "90th_percentile": 3215.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2612.39, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 2612.39, "10th_percentile": 2612.39, "90th_percentile": 2612.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 3215.25, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 3215.25, "10th_percentile": 3215.25, "90th_percentile": 3215.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 1286.1, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1286.1, "10th_percentile": 1286.1, "90th_percentile": 1286.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 3295.63, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 3295.63, "10th_percentile": 3295.63, "90th_percentile": 3295.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 4019.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $4,019.06 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 4019.06, "10th_percentile": 4019.06, "90th_percentile": 4019.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $4,019.06 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 4019.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 4019.06, "10th_percentile": 4019.06, "90th_percentile": 4019.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 2343.11, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2343.11, "10th_percentile": 2343.11, "90th_percentile": 2343.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 2009.53, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2009.53, "10th_percentile": 2009.53, "90th_percentile": 2009.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 4019.06, "10th_percentile": 4019.06, "90th_percentile": 4019.06, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 4019.06, "10th_percentile": 4019.06, "90th_percentile": 4019.06, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4019.06, "10th_percentile": 4019.06, "90th_percentile": 4019.06, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4019.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4019.06, "10th_percentile": 4019.06, "90th_percentile": 4019.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "ADPT PERF 0.25IN STRL", "code_information": [ { "code": "SUP-153803", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 11.21, "maximum": 84.84, "setting": "outpatient", "gross_charge": 41.53, "discounted_cash": 29.07, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 41.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 63.19, "10th_percentile": 45.86, "90th_percentile": 80.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 84.84, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 63.19, "10th_percentile": 45.86, "90th_percentile": 80.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 41.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 63.19, "10th_percentile": 45.86, "90th_percentile": 80.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 84.84, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 63.19, "10th_percentile": 45.86, "90th_percentile": 80.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 41.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 63.19, "10th_percentile": 45.86, "90th_percentile": 80.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 84.84, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 63.19, "10th_percentile": 45.86, "90th_percentile": 80.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 41.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 63.19, "10th_percentile": 45.86, "90th_percentile": 80.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 84.84, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 63.19, "10th_percentile": 45.86, "90th_percentile": 80.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 41.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 63.19, "10th_percentile": 45.86, "90th_percentile": 80.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 84.84, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 63.19, "10th_percentile": 45.86, "90th_percentile": 80.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 41.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 63.19, "10th_percentile": 45.86, "90th_percentile": 80.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 84.84, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 63.19, "10th_percentile": 45.86, "90th_percentile": 80.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 84.84, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 84.84, "10th_percentile": 84.84, "90th_percentile": 84.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 41.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 63.19, "10th_percentile": 45.86, "90th_percentile": 80.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 84.84, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 63.19, "10th_percentile": 45.86, "90th_percentile": 80.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 41.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 63.19, "10th_percentile": 45.86, "90th_percentile": 80.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 84.84, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 63.19, "10th_percentile": 45.86, "90th_percentile": 80.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 38.18, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 38.18, "10th_percentile": 38.18, "90th_percentile": 38.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 38.18, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 38.18, "10th_percentile": 38.18, "90th_percentile": 38.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 38.18, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 38.18, "10th_percentile": 38.18, "90th_percentile": 38.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 11.21, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17.06, "10th_percentile": 12.38, "90th_percentile": 21.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 22.91, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17.06, "10th_percentile": 12.38, "90th_percentile": 21.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 22.91, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 22.91, "10th_percentile": 22.91, "90th_percentile": 22.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 42.42, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 42.42, "10th_percentile": 42.42, "90th_percentile": 42.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 42.42, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 42.42, "10th_percentile": 42.42, "90th_percentile": 42.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 19.85, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 19.85, "10th_percentile": 19.85, "90th_percentile": 19.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 49.21, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 49.21, "10th_percentile": 49.21, "90th_percentile": 49.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 59.39, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 59.39, "10th_percentile": 59.39, "90th_percentile": 59.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" } ] } ] }, { "description": "ADPT SLV ADJ FEM NK MOD UNITRX PCA +10MM", "code_information": [ { "code": "SUP-129129", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 29.98, "maximum": 231.14, "setting": "outpatient", "gross_charge": 231.14, "discounted_cash": 161.8, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 62.41, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.95, "10th_percentile": 39.26, "90th_percentile": 61.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 57.95, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.95, "10th_percentile": 39.26, "90th_percentile": 61.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 34.59, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.95, "10th_percentile": 39.26, "90th_percentile": 61.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 34.59, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 34.59, "10th_percentile": 34.59, "90th_percentile": 34.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 29.98, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 29.98, "10th_percentile": 29.98, "90th_percentile": 29.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 115.57, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 115.57, "10th_percentile": 115.57, "90th_percentile": 115.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 104.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 104.01, "10th_percentile": 104.01, "90th_percentile": 104.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 222.88, "10th_percentile": 216.28, "90th_percentile": 229.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 222.88, "10th_percentile": 216.28, "90th_percentile": 229.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 214.63, "10th_percentile": 214.63, "90th_percentile": 214.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 222.88, "10th_percentile": 216.28, "90th_percentile": 229.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 222.88, "10th_percentile": 216.28, "90th_percentile": 229.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 222.88, "10th_percentile": 216.28, "90th_percentile": 229.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 222.88, "10th_percentile": 216.28, "90th_percentile": 229.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 222.88, "10th_percentile": 216.28, "90th_percentile": 229.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 222.88, "10th_percentile": 216.28, "90th_percentile": 229.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 222.88, "10th_percentile": 216.28, "90th_percentile": 229.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 222.88, "10th_percentile": 216.28, "90th_percentile": 229.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 222.88, "10th_percentile": 216.28, "90th_percentile": 229.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 222.88, "10th_percentile": 216.28, "90th_percentile": 229.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 222.88, "10th_percentile": 216.28, "90th_percentile": 229.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 222.88, "10th_percentile": 216.28, "90th_percentile": 229.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 149.78, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2464.5, "10th_percentile": 2464.5, "90th_percentile": 2464.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 134.29, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2143.36, "10th_percentile": 2143.36, "90th_percentile": 2143.36, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 53.86, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 915.61, "10th_percentile": 915.61, "90th_percentile": 915.61, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 44.84, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 1051.1, "10th_percentile": 1051.1, "90th_percentile": 1051.1, "count": "12", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 92.46, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 92.46, "10th_percentile": 92.46, "90th_percentile": 92.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 92.46, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 92.46, "10th_percentile": 92.46, "90th_percentile": 92.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 69.34, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 1290.36, "10th_percentile": 1290.36, "90th_percentile": 1290.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 81.59, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 81.59, "10th_percentile": 81.59, "90th_percentile": 81.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 196.47, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 196.47, "10th_percentile": 196.47, "90th_percentile": 196.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 184.91, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 184.91, "10th_percentile": 184.91, "90th_percentile": 184.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 150.24, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 150.24, "10th_percentile": 150.24, "90th_percentile": 150.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 184.91, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 184.91, "10th_percentile": 184.91, "90th_percentile": 184.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 73.96, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 73.96, "10th_percentile": 73.96, "90th_percentile": 73.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 189.53, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 189.53, "10th_percentile": 189.53, "90th_percentile": 189.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $231.14 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $231.14 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 134.75, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.75, "10th_percentile": 134.75, "90th_percentile": 134.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 115.57, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 115.57, "10th_percentile": 115.57, "90th_percentile": 115.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ADPT SLV FEM C TAPR UNIV +5MM TI", "code_information": [ { "code": "SUP-123261", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 29.98, "maximum": 1040.26, "setting": "outpatient", "gross_charge": 1040.26, "discounted_cash": 728.18, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 280.87, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.33, "10th_percentile": 41.09, "90th_percentile": 215.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 62.41, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.33, "10th_percentile": 41.09, "90th_percentile": 215.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 56.26, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.33, "10th_percentile": 41.09, "90th_percentile": 215.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 34.59, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.33, "10th_percentile": 41.09, "90th_percentile": 215.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 280.87, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 157.73, "10th_percentile": 59.22, "90th_percentile": 256.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 34.59, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 157.73, "10th_percentile": 59.22, "90th_percentile": 256.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 603.35, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 603.35, "10th_percentile": 603.35, "90th_percentile": 603.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 728.18, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 728.18, "10th_percentile": 728.18, "90th_percentile": 728.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 243.42, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 136.7, "10th_percentile": 51.32, "90th_percentile": 222.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 29.98, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 136.7, "10th_percentile": 51.32, "90th_percentile": 222.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 520.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 520.13, "10th_percentile": 520.13, "90th_percentile": 520.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 115.57, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 317.85, "10th_percentile": 156.03, "90th_percentile": 479.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 520.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 317.85, "10th_percentile": 156.03, "90th_percentile": 479.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 468.12, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 468.12, "10th_percentile": 468.12, "90th_percentile": 468.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 468.12, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 468.12, "10th_percentile": 468.12, "90th_percentile": 468.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 104.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 286.06, "10th_percentile": 140.42, "90th_percentile": 431.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 468.12, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 286.06, "10th_percentile": 140.42, "90th_percentile": 431.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 208.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 231.14, "10th_percentile": 212.93, "90th_percentile": 878.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 231.14, "10th_percentile": 212.93, "90th_percentile": 878.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1040.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 231.14, "10th_percentile": 212.93, "90th_percentile": 878.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1040.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1040.26, "10th_percentile": 1040.26, "90th_percentile": 1040.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1040.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 624.32, "10th_percentile": 291.57, "90th_percentile": 957.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 208.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 624.32, "10th_percentile": 291.57, "90th_percentile": 957.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1040.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 212.93, "90th_percentile": 878.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 212.93, "90th_percentile": 878.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 208.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 212.93, "90th_percentile": 878.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 208.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 212.93, "90th_percentile": 878.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 212.93, "90th_percentile": 878.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1040.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 212.93, "90th_percentile": 878.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 208.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 212.93, "90th_percentile": 878.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 212.93, "90th_percentile": 878.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1040.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 212.93, "90th_percentile": 878.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 208.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 212.93, "90th_percentile": 878.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 212.93, "90th_percentile": 878.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1040.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 212.93, "90th_percentile": 878.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1040.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 212.93, "90th_percentile": 878.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 212.93, "90th_percentile": 878.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 208.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 212.93, "90th_percentile": 878.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 208.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 212.93, "90th_percentile": 878.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 212.93, "90th_percentile": 878.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1040.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 212.93, "90th_percentile": 878.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 149.78, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2464.5, "10th_percentile": 2464.5, "90th_percentile": 2464.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 134.29, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2143.36, "10th_percentile": 2143.36, "90th_percentile": 2143.36, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 53.86, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 915.61, "10th_percentile": 915.61, "90th_percentile": 915.61, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 44.84, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 1051.1, "10th_percentile": 1051.1, "90th_percentile": 1051.1, "count": "12", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 92.46, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 92.46, "10th_percentile": 92.46, "90th_percentile": 92.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 92.46, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 92.46, "10th_percentile": 92.46, "90th_percentile": 92.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 69.34, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 1290.36, "10th_percentile": 1290.36, "90th_percentile": 1290.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 81.59, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 81.59, "10th_percentile": 81.59, "90th_percentile": 81.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 196.47, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 196.47, "10th_percentile": 196.47, "90th_percentile": 196.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 184.91, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 184.91, "10th_percentile": 184.91, "90th_percentile": 184.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 150.24, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 150.24, "10th_percentile": 150.24, "90th_percentile": 150.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 184.91, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 184.91, "10th_percentile": 184.91, "90th_percentile": 184.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 73.96, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 73.96, "10th_percentile": 73.96, "90th_percentile": 73.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 189.53, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 189.53, "10th_percentile": 189.53, "90th_percentile": 189.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $231.14 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $231.14 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 134.75, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.75, "10th_percentile": 134.75, "90th_percentile": 134.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 115.57, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 115.57, "10th_percentile": 115.57, "90th_percentile": 115.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ADPT SLV FEM MRSE C TAPR", "code_information": [ { "code": "SUP-144617", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 69.87, "maximum": 1021.98, "setting": "outpatient", "gross_charge": 1021.98, "discounted_cash": 715.39, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 275.93, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 135.08, "10th_percentile": 91.51, "90th_percentile": 247.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 135.08, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 135.08, "10th_percentile": 91.51, "90th_percentile": 247.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 80.62, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 135.08, "10th_percentile": 91.51, "90th_percentile": 247.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 80.62, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 178.28, "10th_percentile": 100.15, "90th_percentile": 256.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 275.93, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 178.28, "10th_percentile": 100.15, "90th_percentile": 256.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 592.75, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 592.75, "10th_percentile": 592.75, "90th_percentile": 592.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 715.39, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 715.39, "10th_percentile": 715.39, "90th_percentile": 715.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 69.87, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 154.5, "10th_percentile": 86.8, "90th_percentile": 222.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 239.14, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 154.5, "10th_percentile": 86.8, "90th_percentile": 222.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 510.99, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 510.99, "10th_percentile": 510.99, "90th_percentile": 510.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 510.99, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 510.99, "10th_percentile": 510.99, "90th_percentile": 510.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 459.89, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 459.89, "10th_percentile": 459.89, "90th_percentile": 459.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 459.89, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 459.89, "10th_percentile": 459.89, "90th_percentile": 459.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 459.89, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 459.89, "10th_percentile": 459.89, "90th_percentile": 459.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 500.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 761.13, "10th_percentile": 552.46, "90th_percentile": 969.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1021.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 761.13, "10th_percentile": 552.46, "90th_percentile": 969.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1021.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1021.98, "10th_percentile": 1021.98, "90th_percentile": 1021.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 500.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 761.13, "10th_percentile": 552.46, "90th_percentile": 969.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1021.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 761.13, "10th_percentile": 552.46, "90th_percentile": 969.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 500.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 761.13, "10th_percentile": 552.46, "90th_percentile": 969.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1021.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 761.13, "10th_percentile": 552.46, "90th_percentile": 969.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1021.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 761.13, "10th_percentile": 552.46, "90th_percentile": 969.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 500.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 761.13, "10th_percentile": 552.46, "90th_percentile": 969.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 500.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 761.13, "10th_percentile": 552.46, "90th_percentile": 969.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1021.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 761.13, "10th_percentile": 552.46, "90th_percentile": 969.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 500.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 761.13, "10th_percentile": 552.46, "90th_percentile": 969.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1021.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 500.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 761.13, "10th_percentile": 552.46, "90th_percentile": 969.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1021.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 761.13, "10th_percentile": 552.46, "90th_percentile": 969.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "ADPTR TBE FDNG UNIV Y 20FR", "code_information": [ { "code": "SUP-301935", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 9.39, "maximum": 171.73, "setting": "outpatient", "gross_charge": 34.77, "discounted_cash": 24.34, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 34.77, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 171.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 103.25, "10th_percentile": 48.47, "90th_percentile": 158.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 34.77, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 103.25, "10th_percentile": 48.47, "90th_percentile": 158.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 171.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 34.77, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 103.25, "10th_percentile": 48.47, "90th_percentile": 158.03, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 171.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 103.25, "10th_percentile": 48.47, "90th_percentile": 158.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 171.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 103.25, "10th_percentile": 48.47, "90th_percentile": 158.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 34.77, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 103.25, "10th_percentile": 48.47, "90th_percentile": 158.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 77.28, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 77.28, "10th_percentile": 77.28, "90th_percentile": 77.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 77.28, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 77.28, "10th_percentile": 77.28, "90th_percentile": 77.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 77.28, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 77.28, "10th_percentile": 77.28, "90th_percentile": 77.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 46.37, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 27.88, "10th_percentile": 13.09, "90th_percentile": 42.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 9.39, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 27.88, "10th_percentile": 13.09, "90th_percentile": 42.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 46.37, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 46.37, "10th_percentile": 46.37, "90th_percentile": 46.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 85.87, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 85.87, "10th_percentile": 85.87, "90th_percentile": 85.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 85.87, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 85.87, "10th_percentile": 85.87, "90th_percentile": 85.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 40.18, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 40.18, "10th_percentile": 40.18, "90th_percentile": 40.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 40.18, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 40.18, "10th_percentile": 40.18, "90th_percentile": 40.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC SEIU HEALTHLINK", "standard_charge_dollar": 94.45, "standard_charge_percentage": 55.0, "standard_charge_algorithm": "All Services; 55% Billed", "median_amount": 94.45, "10th_percentile": 94.45, "90th_percentile": 94.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 55% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 99.6, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 99.6, "10th_percentile": 99.6, "90th_percentile": 99.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 120.21, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 120.21, "10th_percentile": 120.21, "90th_percentile": 120.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "gross_charge": 216220.17, "discounted_cash": 151354.12, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.810282169; Using historical claim(s); Scope: All Financial Classes; Cases: 93; All IP Services - OON; 100% Billed", "median_amount": 216128.92, "10th_percentile": 216128.92, "90th_percentile": 216128.92, "count": "93", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.810282169; Using historical claim(s); Scope: All Financial Classes; Cases: 93; All IP Services; 100% Billed", "median_amount": 216128.92, "10th_percentile": 216128.92, "90th_percentile": 216128.92, "count": "93", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.764307766; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services (Non-Contracted); 100% Billed", "median_amount": 216128.92, "10th_percentile": 152916.98, "90th_percentile": 282919.16, "count": "100", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.810282169; Using historical claim(s); Scope: All Financial Classes; Cases: 93; All IP Services (Non-Contracted); 100% Billed", "median_amount": 216128.92, "10th_percentile": 152916.98, "90th_percentile": 282919.16, "count": "100", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.824702338; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services (Non-Contracted); 100% Billed", "median_amount": 216128.92, "10th_percentile": 152916.98, "90th_percentile": 282919.16, "count": "100", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.824702338; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 216128.92, "10th_percentile": 152916.98, "90th_percentile": 282919.16, "count": "100", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.810282169; Using historical claim(s); Scope: All Financial Classes; Cases: 93; All IP Services; 100% Billed", "median_amount": 216128.92, "10th_percentile": 152916.98, "90th_percentile": 282919.16, "count": "100", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.764307766; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 216128.92, "10th_percentile": 152916.98, "90th_percentile": 282919.16, "count": "100", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.764307766; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 216128.92, "10th_percentile": 152916.98, "90th_percentile": 282919.16, "count": "100", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.810282169; Using historical claim(s); Scope: All Financial Classes; Cases: 93; All IP Services; 100% Billed", "median_amount": 216128.92, "10th_percentile": 152916.98, "90th_percentile": 282919.16, "count": "100", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.824702338; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 216128.92, "10th_percentile": 152916.98, "90th_percentile": 282919.16, "count": "100", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.764307766; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 216128.92, "10th_percentile": 152916.98, "90th_percentile": 282919.16, "count": "100", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.810282169; Using historical claim(s); Scope: All Financial Classes; Cases: 93; All IP Services; 100% Billed", "median_amount": 216128.92, "10th_percentile": 152916.98, "90th_percentile": 282919.16, "count": "100", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.824702338; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 216128.92, "10th_percentile": 152916.98, "90th_percentile": 282919.16, "count": "100", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.764307766; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 216128.92, "10th_percentile": 152916.98, "90th_percentile": 282919.16, "count": "100", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.810282169; Using historical claim(s); Scope: All Financial Classes; Cases: 93; All IP Services; 100% Billed", "median_amount": 216128.92, "10th_percentile": 152916.98, "90th_percentile": 282919.16, "count": "100", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.824702338; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 216128.92, "10th_percentile": 152916.98, "90th_percentile": 282919.16, "count": "100", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.824702338; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 216128.92, "10th_percentile": 152916.98, "90th_percentile": 282919.16, "count": "100", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.810282169; Using historical claim(s); Scope: All Financial Classes; Cases: 93; All IP Services; 100% Billed", "median_amount": 216128.92, "10th_percentile": 152916.98, "90th_percentile": 282919.16, "count": "100", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.764307766; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 216128.92, "10th_percentile": 152916.98, "90th_percentile": 282919.16, "count": "100", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.824702338; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 216128.92, "10th_percentile": 152916.98, "90th_percentile": 282919.16, "count": "100", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.810282169; Using historical claim(s); Scope: All Financial Classes; Cases: 93; All IP Services; 100% Billed", "median_amount": 216128.92, "10th_percentile": 152916.98, "90th_percentile": 282919.16, "count": "100", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.764307766; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 216128.92, "10th_percentile": 152916.98, "90th_percentile": 282919.16, "count": "100", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.824702338; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 299616.72, "10th_percentile": 299616.72, "90th_percentile": 299616.72, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.764307766; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 218365.36, "10th_percentile": 153364.27, "90th_percentile": 283366.47, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.824702338; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 218365.36, "10th_percentile": 153364.27, "90th_percentile": 283366.47, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Re-evaluated: HLB.810282169; Using historical claim(s); Scope: All Financial Classes; Cases: 93; Stoploss; 80% Billed", "median_amount": 172903.14, "10th_percentile": 172903.14, "90th_percentile": 172903.14, "count": "93", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_percentage": 30.0, "standard_charge_algorithm": "Re-evaluated: HLB.810282169; Using historical claim(s); Scope: All Financial Classes; Cases: 93; All IP Services; 30% Billed", "median_amount": 64838.68, "10th_percentile": 64838.68, "90th_percentile": 64838.68, "count": "93", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_percentage": 19.4, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 41929.04, "10th_percentile": 41929.04, "90th_percentile": 41929.04, "count": "93", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_percentage": 85.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 183709.58, "10th_percentile": 183709.58, "90th_percentile": 183709.58, "count": "93", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 177225.7, "10th_percentile": 177225.7, "90th_percentile": 177225.7, "count": "93", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_percentage": 40.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 86451.57, "10th_percentile": 86451.57, "90th_percentile": 86451.57, "count": "93", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_percentage": 40.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 86451.57, "10th_percentile": 86451.57, "90th_percentile": 86451.57, "count": "93", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 118870.9, "10th_percentile": 118870.9, "90th_percentile": 118870.9, "count": "93", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Re-evaluated: HLB.810282169; Using historical claim(s); Scope: All Financial Classes; Cases: 93; Inpatient Services; 50% Billed", "median_amount": 108064.46, "10th_percentile": 108064.46, "90th_percentile": 108064.46, "count": "93", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 128936.45, "10th_percentile": 112238.87, "90th_percentile": 145634.03, "count": "95", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 128936.45, "10th_percentile": 112238.87, "90th_percentile": 145634.03, "count": "95", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 116042.77, "10th_percentile": 101014.97, "90th_percentile": 131070.56, "count": "95", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 116042.77, "10th_percentile": 101014.97, "90th_percentile": 131070.56, "count": "95", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.837128611; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 39% Billed", "median_amount": 88827.91, "10th_percentile": 66409.82, "90th_percentile": 111246.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.824702338; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 39% Billed", "median_amount": 88827.91, "10th_percentile": 66409.82, "90th_percentile": 111246.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: HLB.824702338; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All Inpatient Services; 70% Billed", "median_amount": 209731.7, "10th_percentile": 209731.7, "90th_percentile": 209731.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Re-evaluated: HLB.824702338; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services (Non-Contracted); 55% Billed", "median_amount": 164789.2, "10th_percentile": 164789.2, "90th_percentile": 164789.2, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 149808.42, "10th_percentile": 149808.42, "90th_percentile": 149808.42, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 134827.52, "10th_percentile": 134827.52, "90th_percentile": 134827.52, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 134827.52, "10th_percentile": 134827.52, "90th_percentile": 134827.52, "count": "1 through 10", "methodology": "percent of total billed charges" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "gross_charge": 159875.02, "discounted_cash": 111912.51, "payers_information": [ { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 159874.77, "10th_percentile": 159874.77, "90th_percentile": 159874.77, "count": "35", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.841225788; Using historical claim(s); Scope: All Financial Classes; Cases: 35; All IP Services - OON; 100% Billed", "median_amount": 159874.77, "10th_percentile": 159874.77, "90th_percentile": 159874.77, "count": "35", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.841225788; Using historical claim(s); Scope: All Financial Classes; Cases: 35; All IP Services; 100% Billed", "median_amount": 159874.77, "10th_percentile": 159874.77, "90th_percentile": 159874.77, "count": "35", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.807344444; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services (Non-Contracted); 100% Billed", "median_amount": 141054.31, "10th_percentile": 107233.88, "90th_percentile": 156110.69, "count": "41", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.795842606; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services (Non-Contracted); 100% Billed", "median_amount": 141054.31, "10th_percentile": 107233.88, "90th_percentile": 156110.69, "count": "41", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.841225788; Using historical claim(s); Scope: All Financial Classes; Cases: 35; All IP Services (Non-Contracted); 100% Billed", "median_amount": 141054.31, "10th_percentile": 107233.88, "90th_percentile": 156110.69, "count": "41", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.841225788; Using historical claim(s); Scope: All Financial Classes; Cases: 35; All IP Services; 100% Billed", "median_amount": 141054.31, "10th_percentile": 107233.88, "90th_percentile": 156110.69, "count": "41", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.795842606; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 141054.31, "10th_percentile": 107233.88, "90th_percentile": 156110.69, "count": "41", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.807344444; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 141054.31, "10th_percentile": 107233.88, "90th_percentile": 156110.69, "count": "41", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.807344444; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 141054.31, "10th_percentile": 107233.88, "90th_percentile": 156110.69, "count": "41", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.795842606; 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Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 141054.31, "10th_percentile": 107233.88, "90th_percentile": 156110.69, "count": "41", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.807344444; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 141054.31, "10th_percentile": 107233.88, "90th_percentile": 156110.69, "count": "41", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.795842606; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 141054.31, "10th_percentile": 141054.31, "90th_percentile": 141054.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.795842606; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 119916.55, "10th_percentile": 103006.33, "90th_percentile": 136826.77, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.807344444; Using historical claim(s); Scope: All Financial Classes; Cases: 2; All IP Services; 100% Billed", "median_amount": 119916.55, "10th_percentile": 103006.33, "90th_percentile": 136826.77, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Re-evaluated: HLB.841225788; Using historical claim(s); Scope: All Financial Classes; Cases: 35; Stoploss; 80% Billed", "median_amount": 127899.82, "10th_percentile": 127899.82, "90th_percentile": 127899.82, "count": "35", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_percentage": 30.0, "standard_charge_algorithm": "Re-evaluated: HLB.841225788; Using historical claim(s); Scope: All Financial Classes; Cases: 35; All IP Services; 30% Billed", "median_amount": 47962.43, "10th_percentile": 47962.43, "90th_percentile": 47962.43, "count": "35", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_percentage": 19.4, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 30572.45, "10th_percentile": 30572.45, "90th_percentile": 30572.45, "count": "35", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_percentage": 85.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 135893.56, "10th_percentile": 135893.56, "90th_percentile": 135893.56, "count": "35", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 131097.34, "10th_percentile": 131097.34, "90th_percentile": 131097.34, "count": "35", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_percentage": 40.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 63949.88, "10th_percentile": 63949.88, "90th_percentile": 63949.88, "count": "35", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_percentage": 40.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 63949.88, "10th_percentile": 63949.88, "90th_percentile": 63949.88, "count": "35", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 87931.12, "10th_percentile": 87931.12, "90th_percentile": 87931.12, "count": "35", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Re-evaluated: HLB.841225788; Using historical claim(s); Scope: All Financial Classes; Cases: 35; Inpatient Services; 50% Billed", "median_amount": 79937.39, "10th_percentile": 79937.39, "90th_percentile": 79937.39, "count": "35", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 75232.32, "10th_percentile": 71468.22, "90th_percentile": 78996.42, "count": "39", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "median_amount": 75232.32, "10th_percentile": 71468.22, "90th_percentile": 78996.42, "count": "39", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "median_amount": 67709.06, "10th_percentile": 64321.37, "90th_percentile": 71096.75, "count": "39", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 67709.06, "10th_percentile": 64321.37, "90th_percentile": 71096.75, "count": "39", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.795842606; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 39% Billed", "median_amount": 55011.18, "10th_percentile": 55011.18, "90th_percentile": 55011.18, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: HLB.795842606; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All Inpatient Services; 70% Billed", "median_amount": 98738.02, "10th_percentile": 98738.02, "90th_percentile": 98738.02, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Re-evaluated: HLB.795842606; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services (Non-Contracted); 55% Billed", "median_amount": 77579.88, "10th_percentile": 77579.88, "90th_percentile": 77579.88, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "median_amount": 63474.45, "10th_percentile": 63474.45, "90th_percentile": 63474.45, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "median_amount": 63474.45, "10th_percentile": 63474.45, "90th_percentile": 63474.45, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "median_amount": 70527.2, "10th_percentile": 70527.2, "90th_percentile": 70527.2, "count": "1 through 10", "methodology": "percent of total billed charges" } ] } ] }, { "description": "AFFERA - CABLE CATHETER EXTENSION", "code_information": [ { "code": "SUP-448985", "type": "CDM" }, { "code": "27800001", "type": "LOCAL" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1142.62, "maximum": 23932.2, "setting": "outpatient", "gross_charge": 9245.6, "discounted_cash": 6471.92, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9245.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9245.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 16588.9, "10th_percentile": 10714.26, "90th_percentile": 22463.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 23932.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 16588.9, "10th_percentile": 10714.26, "90th_percentile": 22463.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9245.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 16588.9, "10th_percentile": 10714.26, "90th_percentile": 22463.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 23932.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 16588.9, "10th_percentile": 10714.26, "90th_percentile": 22463.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 23932.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 16588.9, "10th_percentile": 10714.26, "90th_percentile": 22463.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9245.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 16588.9, "10th_percentile": 10714.26, "90th_percentile": 22463.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 9245.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 16588.9, "10th_percentile": 10714.26, "90th_percentile": 22463.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 23932.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 16588.9, "10th_percentile": 10714.26, "90th_percentile": 22463.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1318.41, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3890.05, "10th_percentile": 1832.74, "90th_percentile": 5947.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 6461.69, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3890.05, "10th_percentile": 1832.74, "90th_percentile": 5947.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1318.41, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2496.31, "10th_percentile": 1553.99, "90th_percentile": 5668.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2496.31, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2496.31, "10th_percentile": 1553.99, "90th_percentile": 5668.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 6461.69, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2496.31, "10th_percentile": 1553.99, "90th_percentile": 5668.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 10769.49, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10769.49, "10th_percentile": 10769.49, "90th_percentile": 10769.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 10769.49, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10769.49, "10th_percentile": 10769.49, "90th_percentile": 10769.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 4160.52, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7465.01, "10th_percentile": 4821.42, "90th_percentile": 10108.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 10769.49, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7465.01, "10th_percentile": 4821.42, "90th_percentile": 10108.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 11966.1, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 11966.1, "10th_percentile": 11966.1, "90th_percentile": 11966.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 11966.1, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 8294.45, "10th_percentile": 5357.13, "90th_percentile": 11231.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 4622.8, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 8294.45, "10th_percentile": 5357.13, "90th_percentile": 11231.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1142.62, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 3371.38, "10th_percentile": 1588.37, "90th_percentile": 5154.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 5600.13, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 3371.38, "10th_percentile": 1588.37, "90th_percentile": 5154.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 16752.54, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 16752.54, "10th_percentile": 16752.54, "90th_percentile": 16752.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 13880.68, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 13880.68, "10th_percentile": 13880.68, "90th_percentile": 13880.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 2958.59, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2958.59, "10th_percentile": 2958.59, "90th_percentile": 2958.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 3263.7, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 3263.7, "10th_percentile": 3263.7, "90th_percentile": 3263.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 2773.68, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 2773.68, "10th_percentile": 2773.68, "90th_percentile": 2773.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 1793.65, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 1793.65, "10th_percentile": 1793.65, "90th_percentile": 1793.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 2154.22, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2154.22, "10th_percentile": 2154.22, "90th_percentile": 2154.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 7396.48, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 7396.48, "10th_percentile": 7396.48, "90th_percentile": 7396.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 5371.69, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5371.69, "10th_percentile": 5371.69, "90th_percentile": 5371.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 6009.64, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 6009.64, "10th_percentile": 6009.64, "90th_percentile": 6009.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 7858.76, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 7858.76, "10th_percentile": 7858.76, "90th_percentile": 7858.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 7581.39, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 7581.39, "10th_percentile": 7581.39, "90th_percentile": 7581.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 4622.8, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 4622.8, "10th_percentile": 4622.8, "90th_percentile": 4622.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 7396.48, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 7396.48, "10th_percentile": 7396.48, "90th_percentile": 7396.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 9245.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $9,245.60 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 9245.6, "10th_percentile": 9245.6, "90th_percentile": 9245.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $9,245.60 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 5991.15, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5991.15, "10th_percentile": 5991.15, "90th_percentile": 5991.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 5390.18, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5390.18, "10th_percentile": 5390.18, "90th_percentile": 5390.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 9245.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 9245.6, "10th_percentile": 9245.6, "90th_percentile": 9245.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 3698.24, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 3698.24, "10th_percentile": 3698.24, "90th_percentile": 3698.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 3698.24, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 3698.24, "10th_percentile": 3698.24, "90th_percentile": 3698.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 9245.6, "10th_percentile": 9245.6, "90th_percentile": 9245.6, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 9245.6, "10th_percentile": 9245.6, "90th_percentile": 9245.6, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 9245.6, "10th_percentile": 9245.6, "90th_percentile": 9245.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9245.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9245.6, "10th_percentile": 9245.6, "90th_percentile": 9245.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "gross_charge": 63796.24, "discounted_cash": 44657.37, "payers_information": [ { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 63796.25, "10th_percentile": 63796.25, "90th_percentile": 63796.25, "count": "18", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.840118598; Using historical claim(s); Scope: All Financial Classes; Cases: 18; All IP Services - OON; 100% Billed", "median_amount": 63796.25, "10th_percentile": 63796.25, "90th_percentile": 63796.25, "count": "18", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.840118598; Using historical claim(s); Scope: All Financial Classes; Cases: 18; All IP Services; 100% Billed", "median_amount": 63796.25, "10th_percentile": 63796.25, "90th_percentile": 63796.25, "count": "18", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.825521106; Using historical claim(s); Scope: All Financial Classes; Cases: 83; All IP Services (Non-Contracted); 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.840118598; Using historical claim(s); Scope: All Financial Classes; Cases: 18; All IP Services (Non-Contracted); 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.853907435; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All IP Services (Non-Contracted); 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services (Non-Contracted); 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.870424752; Using new claim; Scope: All Financial Classes; Cases: 11; All IP Services (Non-Contracted); 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.853072868; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services (Non-Contracted); 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services (Non-Contracted); 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 40937.5, "10th_percentile": 33712.1, "90th_percentile": 44938.61, "count": "45", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.853072868; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 100% Billed", "median_amount": 40937.5, "10th_percentile": 33712.1, "90th_percentile": 44938.61, "count": "45", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.870424752; Using new claim; Scope: All Financial Classes; Cases: 11; All IP Services; 100% Billed", "median_amount": 40937.5, "10th_percentile": 33712.1, "90th_percentile": 44938.61, "count": "45", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 40937.5, "10th_percentile": 33712.1, "90th_percentile": 44938.61, "count": "45", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.853907435; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All IP Services; 100% Billed", "median_amount": 40937.5, "10th_percentile": 33712.1, "90th_percentile": 44938.61, "count": "45", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 41860.94, "10th_percentile": 34829.0, "90th_percentile": 60552.5, "count": "128", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.853072868; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 100% Billed", "median_amount": 41860.94, "10th_percentile": 34829.0, "90th_percentile": 60552.5, "count": "128", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.870424752; Using new claim; Scope: All Financial Classes; Cases: 11; All IP Services; 100% Billed", "median_amount": 41860.94, "10th_percentile": 34829.0, "90th_percentile": 60552.5, "count": "128", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 41860.94, "10th_percentile": 34829.0, "90th_percentile": 60552.5, "count": "128", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.853907435; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All IP Services; 100% Billed", "median_amount": 41860.94, "10th_percentile": 34829.0, "90th_percentile": 60552.5, "count": "128", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.825521106; Using historical claim(s); Scope: All Financial Classes; Cases: 83; All IP Services; 100% Billed", "median_amount": 41860.94, "10th_percentile": 34829.0, "90th_percentile": 60552.5, "count": "128", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.853072868; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.870424752; Using new claim; Scope: All Financial Classes; Cases: 11; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.853907435; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.840118598; Using historical claim(s); Scope: All Financial Classes; Cases: 18; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.825521106; Using historical claim(s); Scope: All Financial Classes; Cases: 83; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.825521106; Using historical claim(s); Scope: All Financial Classes; Cases: 83; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.840118598; Using historical claim(s); Scope: All Financial Classes; Cases: 18; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.853907435; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.870424752; Using new claim; Scope: All Financial Classes; Cases: 11; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.853072868; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.853072868; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.870424752; Using new claim; Scope: All Financial Classes; Cases: 11; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.853907435; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.840118598; Using historical claim(s); Scope: All Financial Classes; Cases: 18; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.825521106; Using historical claim(s); Scope: All Financial Classes; Cases: 83; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.853072868; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.870424752; Using new claim; Scope: All Financial Classes; Cases: 11; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.853907435; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.840118598; Using historical claim(s); Scope: All Financial Classes; Cases: 18; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.825521106; Using historical claim(s); Scope: All Financial Classes; Cases: 83; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.825521106; Using historical claim(s); Scope: All Financial Classes; Cases: 83; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.840118598; Using historical claim(s); Scope: All Financial Classes; Cases: 18; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.853907435; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.870424752; Using new claim; Scope: All Financial Classes; Cases: 11; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.853072868; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.825521106; Using historical claim(s); Scope: All Financial Classes; Cases: 83; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.840118598; Using historical claim(s); Scope: All Financial Classes; Cases: 18; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.853907435; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.870424752; Using new claim; Scope: All Financial Classes; Cases: 11; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.853072868; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 35945.9, "90th_percentile": 68169.85, "count": "146", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_percentage": 30.0, "standard_charge_algorithm": "Re-evaluated: HLB.840118598; Using historical claim(s); Scope: All Financial Classes; Cases: 18; All IP Services; 30% Billed", "median_amount": 19138.88, "10th_percentile": 19138.88, "90th_percentile": 19138.88, "count": "18", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_percentage": 19.4, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 12376.5, "10th_percentile": 12376.5, "90th_percentile": 12376.5, "count": "18", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 41467.57, "10th_percentile": 41467.57, "90th_percentile": 41467.57, "count": "18", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_percentage": 85.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 54226.82, "10th_percentile": 54226.82, "90th_percentile": 54226.82, "count": "18", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 52312.93, "10th_percentile": 52312.93, "90th_percentile": 52312.93, "count": "18", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_percentage": 40.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 25518.5, "10th_percentile": 25518.5, "90th_percentile": 25518.5, "count": "18", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_percentage": 40.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 25518.5, "10th_percentile": 25518.5, "90th_percentile": 25518.5, "count": "18", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All Inpatient Services; 70% Billed", "median_amount": 29302.66, "10th_percentile": 24380.3, "90th_percentile": 34764.28, "count": "477", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: HLB.853072868; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All Inpatient Services; 70% Billed", "median_amount": 29302.66, "10th_percentile": 24380.3, "90th_percentile": 34764.28, "count": "477", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: HLB.870424752; Using new claim; Scope: All Financial Classes; Cases: 11; All Inpatient Services; 70% Billed", "median_amount": 29302.66, "10th_percentile": 24380.3, "90th_percentile": 34764.28, "count": "477", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All Inpatient Services; 70% Billed", "median_amount": 29302.66, "10th_percentile": 24380.3, "90th_percentile": 34764.28, "count": "477", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: HLB.853907435; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All Inpatient Services; 70% Billed", "median_amount": 29302.66, "10th_percentile": 24380.3, "90th_percentile": 34764.28, "count": "477", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: HLB.860735180; Using historical claim(s); Scope: All Financial Classes; Cases: 432; All Inpatient Services; 70% Billed", "median_amount": 29302.66, "10th_percentile": 24380.3, "90th_percentile": 34764.28, "count": "477", "methodology": "percent of total billed charges" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Re-evaluated: HLB.860735180; Using historical claim(s); Scope: All Financial Classes; Cases: 432; All IP Services (Non-Contracted); 55% Billed", "median_amount": 23023.52, "10th_percentile": 19155.96, "90th_percentile": 27314.78, "count": "477", "methodology": "percent of total billed charges" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Re-evaluated: HLB.853907435; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All IP Services (Non-Contracted); 55% Billed", "median_amount": 23023.52, "10th_percentile": 19155.96, "90th_percentile": 27314.78, "count": "477", "methodology": "percent of total billed charges" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services (Non-Contracted); 55% Billed", "median_amount": 23023.52, "10th_percentile": 19155.96, "90th_percentile": 27314.78, "count": "477", "methodology": "percent of total billed charges" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Re-evaluated: HLB.870424752; Using new claim; Scope: All Financial Classes; Cases: 11; All IP Services (Non-Contracted); 55% Billed", "median_amount": 23023.52, "10th_percentile": 19155.96, "90th_percentile": 27314.78, "count": "477", "methodology": "percent of total billed charges" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Re-evaluated: HLB.853072868; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services (Non-Contracted); 55% Billed", "median_amount": 23023.52, "10th_percentile": 19155.96, "90th_percentile": 27314.78, "count": "477", "methodology": "percent of total billed charges" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services (Non-Contracted); 55% Billed", "median_amount": 23023.52, "10th_percentile": 19155.96, "90th_percentile": 27314.78, "count": "477", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.752841182; Using historical claim(s); Scope: All Financial Classes; Cases: 13; All IP Services; 39% Billed", "median_amount": 15965.63, "10th_percentile": 10847.35, "90th_percentile": 19112.16, "count": "490", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 39% Billed", "median_amount": 15965.63, "10th_percentile": 10847.35, "90th_percentile": 19112.16, "count": "490", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.853072868; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 39% Billed", "median_amount": 15965.63, "10th_percentile": 10847.35, "90th_percentile": 19112.16, "count": "490", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.870424752; Using new claim; Scope: All Financial Classes; Cases: 11; All IP Services; 39% Billed", "median_amount": 15965.63, "10th_percentile": 10847.35, "90th_percentile": 19112.16, "count": "490", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 39% Billed", "median_amount": 15965.63, "10th_percentile": 10847.35, "90th_percentile": 19112.16, "count": "490", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.853907435; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All IP Services; 39% Billed", "median_amount": 15965.63, "10th_percentile": 10847.35, "90th_percentile": 19112.16, "count": "490", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.860735180; Using historical claim(s); Scope: All Financial Classes; Cases: 432; All IP Services; 39% Billed", "median_amount": 15965.63, "10th_percentile": 10847.35, "90th_percentile": 19112.16, "count": "490", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Re-evaluated: HLB.840118598; Using historical claim(s); Scope: All Financial Classes; Cases: 18; Inpatient Services; 50% Billed", "median_amount": 31898.13, "10th_percentile": 31898.13, "90th_percentile": 31898.13, "count": "18", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "median_amount": 20468.75, "10th_percentile": 16856.06, "90th_percentile": 22469.31, "count": "45", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 20468.75, "10th_percentile": 16856.06, "90th_percentile": 22469.31, "count": "45", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 20468.75, "10th_percentile": 16856.06, "90th_percentile": 22469.31, "count": "45", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 20468.75, "10th_percentile": 16856.06, "90th_percentile": 22469.31, "count": "45", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 20468.75, "10th_percentile": 16856.06, "90th_percentile": 22469.31, "count": "45", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 20930.47, "10th_percentile": 17414.51, "90th_percentile": 27542.76, "count": "63", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 20930.47, "10th_percentile": 17414.51, "90th_percentile": 27542.76, "count": "63", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 20930.47, "10th_percentile": 17414.51, "90th_percentile": 27542.76, "count": "63", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 20930.47, "10th_percentile": 17414.51, "90th_percentile": 27542.76, "count": "63", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be 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"plan_name": "NMHC CHWN IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 18421.88, "10th_percentile": 15170.45, "90th_percentile": 20222.38, "count": "45", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 18421.88, "10th_percentile": 15170.45, "90th_percentile": 20222.38, "count": "45", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, 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HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 18837.43, "10th_percentile": 15673.06, "90th_percentile": 24788.48, "count": "63", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 18837.43, "10th_percentile": 15673.06, "90th_percentile": 24788.48, "count": "63", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 18837.43, "10th_percentile": 15673.06, "90th_percentile": 24788.48, "count": "63", "methodology": "percent of total billed charges" } ] } ] }, { "description": "AGENT BULKING 1ML DURASPHERE EXP SUBMUCOSAL INJ SYR PREFLL", "code_information": [ { "code": "SUP-313296", "type": "CDM" }, { "code": "L8606", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 121.71, "maximum": 1780.03, "setting": "outpatient", "gross_charge": 846.0, "discounted_cash": 592.2, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 846.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 938.43, "10th_percentile": 864.49, "90th_percentile": 1611.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 938.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 938.43, "10th_percentile": 864.49, "90th_percentile": 1611.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1780.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 938.43, "10th_percentile": 864.49, "90th_percentile": 1611.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC 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"All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1780.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 938.43, "10th_percentile": 864.49, "90th_percentile": 1611.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 938.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 938.43, "10th_percentile": 864.49, "90th_percentile": 1611.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 846.0, 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939.4, "90th_percentile": 1686.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1780.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1780.03, "10th_percentile": 1780.03, "90th_percentile": 1780.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 846.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 938.43, "10th_percentile": 864.49, "90th_percentile": 1611.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 938.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 938.43, "10th_percentile": 864.49, "90th_percentile": 1611.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1780.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 938.43, "10th_percentile": 864.49, "90th_percentile": 1611.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 801.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 801.01, "10th_percentile": 801.01, "90th_percentile": 801.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 801.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 801.01, "10th_percentile": 801.01, "90th_percentile": 801.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 422.29, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 611.65, "10th_percentile": 460.16, "90th_percentile": 763.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 801.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 611.65, "10th_percentile": 460.16, "90th_percentile": 763.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 140.43, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 310.52, "10th_percentile": 174.45, "90th_percentile": 446.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 480.61, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 310.52, "10th_percentile": 174.45, "90th_percentile": 446.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 140.43, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 240.9, "10th_percentile": 166.83, "90th_percentile": 412.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 228.42, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 240.9, "10th_percentile": 166.83, "90th_percentile": 412.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 253.38, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 240.9, "10th_percentile": 166.83, "90th_percentile": 412.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 480.61, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 240.9, "10th_percentile": 166.83, "90th_percentile": 412.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 890.02, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 890.02, "10th_percentile": 890.02, "90th_percentile": 890.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 469.22, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 679.62, "10th_percentile": 511.3, "90th_percentile": 847.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 890.02, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 679.62, "10th_percentile": 511.3, "90th_percentile": 847.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 416.53, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 269.12, "10th_percentile": 151.19, "90th_percentile": 387.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 121.71, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 269.12, "10th_percentile": 151.19, "90th_percentile": 387.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1032.42, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1032.42, "10th_percentile": 1032.42, "90th_percentile": 1032.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1246.02, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1246.02, "10th_percentile": 1246.02, "90th_percentile": 1246.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 375.37, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 375.37, "10th_percentile": 375.37, "90th_percentile": 375.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 375.37, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 375.37, "10th_percentile": 375.37, "90th_percentile": 375.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 797.67, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 797.67, "10th_percentile": 797.67, "90th_percentile": 797.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 331.27, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 331.27, "10th_percentile": 331.27, "90th_percentile": 331.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 281.53, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 281.53, "10th_percentile": 281.53, "90th_percentile": 281.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 547.1, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 547.1, "10th_percentile": 547.1, "90th_percentile": 547.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 938.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 938.43, "10th_percentile": 938.43, "90th_percentile": 938.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 769.51, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 769.51, "10th_percentile": 769.51, "90th_percentile": 769.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 609.98, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 609.98, "10th_percentile": 609.98, "90th_percentile": 609.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 750.74, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 750.74, "10th_percentile": 750.74, "90th_percentile": 750.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 469.22, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 469.22, "10th_percentile": 469.22, "90th_percentile": 469.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 750.74, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 750.74, "10th_percentile": 750.74, "90th_percentile": 750.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 300.3, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 300.3, "10th_percentile": 300.3, "90th_percentile": 300.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 182.06, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 995.06, "10th_percentile": 995.06, "90th_percentile": 995.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 608.1, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 608.1, "10th_percentile": 608.1, "90th_percentile": 608.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 218.65, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 218.65, "10th_percentile": 218.65, "90th_percentile": 218.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 545.23, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 545.23, "10th_percentile": 545.23, "90th_percentile": 545.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 938.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $938.43 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 938.43, "10th_percentile": 938.43, "90th_percentile": 938.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $938.43 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 938.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 938.43, "10th_percentile": 938.43, "90th_percentile": 938.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 938.43, "10th_percentile": 938.43, "90th_percentile": 938.43, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 938.43, "10th_percentile": 938.43, "90th_percentile": 938.43, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 938.43, "10th_percentile": 938.43, "90th_percentile": 938.43, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" } ] } ] }, { "description": "AGILE ESO FC 2318MM 9.7CM", "code_information": [ { "code": "SUP-381470", "type": "CDM" }, { "code": "C1874", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 5729.45, "maximum": 24484.82, "setting": "outpatient", "gross_charge": 24484.82, "discounted_cash": 17139.37, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 24484.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 24484.82, "10th_percentile": 24484.82, "90th_percentile": 24484.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 24484.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 24484.82, "10th_percentile": 24484.82, "90th_percentile": 24484.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 24484.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 24484.82, "10th_percentile": 24484.82, "90th_percentile": 24484.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 24484.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 24484.82, "10th_percentile": 24484.82, "90th_percentile": 24484.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 24484.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 24484.82, "10th_percentile": 24484.82, "90th_percentile": 24484.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 24484.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 24484.82, "10th_percentile": 24484.82, "90th_percentile": 24484.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 24484.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 24484.82, "10th_percentile": 24484.82, "90th_percentile": 24484.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 24484.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 24484.82, "10th_percentile": 24484.82, "90th_percentile": 24484.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 24484.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 24484.82, "10th_percentile": 24484.82, "90th_percentile": 24484.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 11018.17, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11018.17, "10th_percentile": 11018.17, "90th_percentile": 11018.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 11018.17, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11018.17, "10th_percentile": 11018.17, "90th_percentile": 11018.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 11018.17, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11018.17, "10th_percentile": 11018.17, "90th_percentile": 11018.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 6610.9, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6610.9, "10th_percentile": 6610.9, "90th_percentile": 6610.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 6610.9, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6610.9, "10th_percentile": 6610.9, "90th_percentile": 6610.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 12242.41, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 12242.41, "10th_percentile": 12242.41, "90th_percentile": 12242.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 12242.41, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 12242.41, "10th_percentile": 12242.41, "90th_percentile": 12242.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 5729.45, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 5729.45, "10th_percentile": 5729.45, "90th_percentile": 5729.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 17139.37, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 17139.37, "10th_percentile": 17139.37, "90th_percentile": 17139.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 14201.2, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 14201.2, "10th_percentile": 14201.2, "90th_percentile": 14201.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "gross_charge": 160656.38, "discounted_cash": 112459.46, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.719608477; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 160448.38, "10th_percentile": 160448.38, "90th_percentile": 160448.38, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.719608477; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services - OON; 100% Billed", "median_amount": 160448.38, "10th_percentile": 160448.38, "90th_percentile": 160448.38, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.719608477; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services (Non-Contracted); 100% Billed", "median_amount": 253522.73, "10th_percentile": 179063.23, "90th_percentile": 360761.88, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.810968570; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services (Non-Contracted); 100% Billed", "median_amount": 253522.73, "10th_percentile": 179063.23, "90th_percentile": 360761.88, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.842647738; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services (Non-Contracted); 100% Billed", "median_amount": 253522.73, "10th_percentile": 179063.23, "90th_percentile": 360761.88, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.719608477; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 253522.73, "10th_percentile": 179063.23, "90th_percentile": 360761.88, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.810968570; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 253522.73, "10th_percentile": 179063.23, "90th_percentile": 360761.88, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.842647738; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 253522.73, "10th_percentile": 179063.23, "90th_percentile": 360761.88, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.719608477; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 253522.73, "10th_percentile": 179063.23, "90th_percentile": 360761.88, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.810968570; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 253522.73, "10th_percentile": 179063.23, "90th_percentile": 360761.88, "count": "1 through 10", "methodology": "percent 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HLB.842647738; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 253522.73, "10th_percentile": 179063.23, "90th_percentile": 360761.88, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.810968570; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 253522.73, "10th_percentile": 179063.23, "90th_percentile": 360761.88, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.719608477; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% 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"methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.842647738; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 253522.73, "10th_percentile": 179063.23, "90th_percentile": 360761.88, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.719608477; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 253522.73, "10th_percentile": 179063.23, "90th_percentile": 360761.88, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.810968570; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 253522.73, "10th_percentile": 179063.23, "90th_percentile": 360761.88, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.842647738; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 253522.73, "10th_percentile": 179063.23, "90th_percentile": 360761.88, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.842647738; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 387571.7, "10th_percentile": 387571.7, "90th_percentile": 387571.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.810968570; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 320547.22, "10th_percentile": 266927.62, "90th_percentile": 374166.78, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.842647738; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 320547.22, "10th_percentile": 266927.62, "90th_percentile": 374166.78, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Re-evaluated: HLB.719608477; Using historical claim(s); Scope: All Financial Classes; Cases: 4; Stoploss; 80% Billed", "median_amount": 128358.7, "10th_percentile": 128358.7, "90th_percentile": 128358.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_percentage": 30.0, "standard_charge_algorithm": "Re-evaluated: HLB.719608477; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 30% Billed", "median_amount": 48134.51, "10th_percentile": 48134.51, "90th_percentile": 48134.51, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.842647738; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 39% Billed", "median_amount": 151152.95, "10th_percentile": 151152.95, "90th_percentile": 151152.95, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: HLB.842647738; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All Inpatient Services; 70% Billed", "median_amount": 271300.2, "10th_percentile": 271300.2, "90th_percentile": 271300.2, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Re-evaluated: HLB.842647738; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services (Non-Contracted); 55% Billed", "median_amount": 213164.42, "10th_percentile": 213164.42, "90th_percentile": 213164.42, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Re-evaluated: HLB.719608477; Using historical claim(s); Scope: All Financial Classes; Cases: 4; Inpatient Services; 50% Billed", "median_amount": 80224.19, "10th_percentile": 80224.19, "90th_percentile": 80224.19, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 137005.02, "10th_percentile": 91580.37, "90th_percentile": 182429.69, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 193785.84, "10th_percentile": 193785.84, "90th_percentile": 193785.84, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 123304.51, "10th_percentile": 82422.32, "90th_percentile": 164186.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 174407.25, "10th_percentile": 174407.25, "90th_percentile": 174407.25, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 174407.25, "10th_percentile": 174407.25, "90th_percentile": 174407.25, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 123304.51, "10th_percentile": 82422.32, "90th_percentile": 164186.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 137005.02, "10th_percentile": 91580.37, "90th_percentile": 182429.69, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_percentage": 40.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 64179.35, "10th_percentile": 64179.35, "90th_percentile": 64179.35, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_percentage": 40.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 64179.35, "10th_percentile": 64179.35, "90th_percentile": 64179.35, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 88246.6, "10th_percentile": 88246.6, "90th_percentile": 88246.6, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_percentage": 85.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 136381.11, "10th_percentile": 136381.11, "90th_percentile": 136381.11, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 131567.67, "10th_percentile": 131567.67, "90th_percentile": 131567.67, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_percentage": 19.4, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 31127.0, "10th_percentile": 31127.0, "90th_percentile": 31127.0, "count": "1 through 10", "methodology": "percent of total billed charges" } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "gross_charge": 141311.6, "discounted_cash": 98918.12, "payers_information": [ { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 140919.34, "10th_percentile": 140919.34, "90th_percentile": 140919.34, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.742872873; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 140919.34, "10th_percentile": 140919.34, "90th_percentile": 140919.34, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.742872873; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services - OON; 100% Billed", "median_amount": 140919.34, "10th_percentile": 140919.34, "90th_percentile": 140919.34, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.742872873; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services (Non-Contracted); 100% Billed", "median_amount": 140919.34, "10th_percentile": 140919.34, "90th_percentile": 140919.34, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.742872873; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 140919.34, "10th_percentile": 140919.34, "90th_percentile": 140919.34, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.742872873; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 140919.34, "10th_percentile": 140919.34, "90th_percentile": 140919.34, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.742872873; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 140919.34, "10th_percentile": 140919.34, "90th_percentile": 140919.34, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.742872873; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 140919.34, "10th_percentile": 140919.34, "90th_percentile": 140919.34, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.742872873; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 140919.34, "10th_percentile": 140919.34, "90th_percentile": 140919.34, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.742872873; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 140919.34, "10th_percentile": 140919.34, "90th_percentile": 140919.34, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Re-evaluated: HLB.742872873; Using historical claim(s); Scope: All Financial Classes; Cases: 4; Stoploss; 80% Billed", "median_amount": 112735.48, "10th_percentile": 112735.48, "90th_percentile": 112735.48, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_percentage": 30.0, "standard_charge_algorithm": "Re-evaluated: HLB.742872873; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 30% Billed", "median_amount": 42275.81, "10th_percentile": 42275.81, "90th_percentile": 42275.81, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Re-evaluated: HLB.742872873; Using historical claim(s); Scope: All Financial Classes; Cases: 4; Inpatient Services; 50% Billed", "median_amount": 70459.68, "10th_percentile": 70459.68, "90th_percentile": 70459.68, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_percentage": 19.4, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 27338.35, "10th_percentile": 27338.35, "90th_percentile": 27338.35, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 77505.65, "10th_percentile": 77505.65, "90th_percentile": 77505.65, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_percentage": 85.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 119781.45, "10th_percentile": 119781.45, "90th_percentile": 119781.45, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 115553.87, "10th_percentile": 115553.87, "90th_percentile": 115553.87, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_percentage": 40.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 56367.74, "10th_percentile": 56367.74, "90th_percentile": 56367.74, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_percentage": 40.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 56367.74, "10th_percentile": 56367.74, "90th_percentile": 56367.74, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 70459.68, "10th_percentile": 70459.68, "90th_percentile": 70459.68, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 63413.71, "10th_percentile": 63413.71, "90th_percentile": 63413.71, "count": "1 through 10", "methodology": "percent of total billed charges" } ] } ] }, { "description": "AICD LEAD STYLETS MODEL 6972 0.014INX64CM", "code_information": [ { "code": "SUP-312691", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 28.02, "maximum": 598.31, "setting": "outpatient", "gross_charge": 214.63, "discounted_cash": 150.24, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 348.68, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 438.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 598.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": 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348.68, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 438.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 598.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 348.68, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 438.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 598.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 348.68, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 438.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 598.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 598.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 438.43, "10th_percentile": 366.63, "90th_percentile": 566.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 348.68, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 438.43, "10th_percentile": 366.63, "90th_percentile": 566.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 438.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 438.43, "10th_percentile": 366.63, "90th_percentile": 566.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 393.56, "10th_percentile": 254.84, "90th_percentile": 550.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 348.68, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 393.56, "10th_percentile": 254.84, "90th_percentile": 550.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 438.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 393.56, "10th_percentile": 254.84, "90th_percentile": 550.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 598.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 393.56, "10th_percentile": 254.84, "90th_percentile": 550.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 214.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 348.68, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 438.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 598.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 348.68, "10th_percentile": 221.23, "90th_percentile": 534.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 156.91, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 197.29, "10th_percentile": 164.99, "90th_percentile": 254.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 197.29, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 197.29, "10th_percentile": 164.99, "90th_percentile": 254.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 269.24, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 197.29, "10th_percentile": 164.99, "90th_percentile": 254.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 156.91, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 197.29, "10th_percentile": 164.99, "90th_percentile": 254.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 197.29, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 197.29, "10th_percentile": 164.99, "90th_percentile": 254.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 269.24, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 197.29, "10th_percentile": 164.99, "90th_percentile": 254.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 104.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 177.1, "10th_percentile": 119.88, "90th_percentile": 247.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 156.91, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 177.1, "10th_percentile": 119.88, "90th_percentile": 247.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 197.29, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 177.1, "10th_percentile": 119.88, "90th_percentile": 247.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 269.24, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 177.1, "10th_percentile": 119.88, "90th_percentile": 247.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 57.95, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 78.28, "10th_percentile": 45.14, "90th_percentile": 139.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 32.33, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 78.28, "10th_percentile": 45.14, "90th_percentile": 139.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 62.41, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 78.28, "10th_percentile": 45.14, "90th_percentile": 139.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 94.14, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 78.28, "10th_percentile": 45.14, "90th_percentile": 139.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 118.38, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 78.28, "10th_percentile": 45.14, "90th_percentile": 139.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 161.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 78.28, "10th_percentile": 45.14, "90th_percentile": 139.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 32.33, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 106.26, "10th_percentile": 50.87, "90th_percentile": 148.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 161.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 106.26, "10th_percentile": 50.87, "90th_percentile": 148.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 118.38, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 106.26, "10th_percentile": 50.87, "90th_percentile": 148.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 94.14, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 106.26, "10th_percentile": 50.87, "90th_percentile": 148.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 299.16, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 219.22, "10th_percentile": 183.32, "90th_percentile": 283.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 219.22, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 219.22, "10th_percentile": 183.32, "90th_percentile": 283.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 174.34, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 219.22, "10th_percentile": 183.32, "90th_percentile": 283.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 115.57, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 196.78, "10th_percentile": 133.2, "90th_percentile": 275.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 174.34, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 196.78, "10th_percentile": 133.2, "90th_percentile": 275.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 219.22, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 196.78, "10th_percentile": 133.2, "90th_percentile": 275.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 299.16, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 196.78, "10th_percentile": 133.2, "90th_percentile": 275.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 28.02, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 92.09, "10th_percentile": 44.09, "90th_percentile": 128.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 81.59, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 92.09, "10th_percentile": 44.09, "90th_percentile": 128.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 102.59, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 92.09, "10th_percentile": 44.09, "90th_percentile": 128.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 140.0, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 92.09, "10th_percentile": 44.09, "90th_percentile": 128.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 347.02, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 254.29, "10th_percentile": 212.64, "90th_percentile": 328.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 254.29, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 254.29, "10th_percentile": 212.64, "90th_percentile": 328.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 202.23, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 254.29, "10th_percentile": 212.64, "90th_percentile": 328.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 244.08, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 306.9, "10th_percentile": 256.64, "90th_percentile": 396.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 306.9, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 306.9, "10th_percentile": 256.64, "90th_percentile": 396.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 418.82, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 306.9, "10th_percentile": 256.64, "90th_percentile": 396.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 92.46, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 92.46, "10th_percentile": 92.46, "90th_percentile": 92.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 92.46, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 92.46, "10th_percentile": 92.46, "90th_percentile": 92.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 81.59, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 81.59, "10th_percentile": 81.59, "90th_percentile": 81.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 189.53, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 189.53, "10th_percentile": 189.53, "90th_percentile": 189.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 69.34, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 69.34, "10th_percentile": 69.34, "90th_percentile": 69.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 115.57, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 115.57, "10th_percentile": 115.57, "90th_percentile": 115.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 134.75, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.75, "10th_percentile": 134.75, "90th_percentile": 134.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 73.96, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 73.96, "10th_percentile": 73.96, "90th_percentile": 73.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 149.78, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 149.78, "10th_percentile": 149.78, "90th_percentile": 149.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 134.29, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.29, "10th_percentile": 134.29, "90th_percentile": 134.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 44.84, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 44.84, "10th_percentile": 44.84, "90th_percentile": 44.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 196.47, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 196.47, "10th_percentile": 196.47, "90th_percentile": 196.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 150.24, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 150.24, "10th_percentile": 150.24, "90th_percentile": 150.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 184.91, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 184.91, "10th_percentile": 184.91, "90th_percentile": 184.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $231.14 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $231.14 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 231.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 53.86, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 53.86, "10th_percentile": 53.86, "90th_percentile": 53.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 184.91, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 184.91, "10th_percentile": 184.91, "90th_percentile": 184.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 231.14, "10th_percentile": 231.14, "90th_percentile": 231.14, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" } ] } ] }, { "description": "AIRWAY GUEDEL 50MM BLUE", "code_information": [ { "code": "SUP-337008", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 0.54, "maximum": 2.32, "setting": "outpatient", "gross_charge": 2.32, "discounted_cash": 1.62, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.32, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.32, "10th_percentile": 2.32, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.32, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.32, "10th_percentile": 2.32, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.32, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.32, "10th_percentile": 2.32, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.32, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.32, "10th_percentile": 2.32, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.32, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.32, "10th_percentile": 2.32, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.32, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.32, "10th_percentile": 2.32, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.32, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.32, "10th_percentile": 2.32, "90th_percentile": 2.32, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.32, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.32, "10th_percentile": 2.32, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2.32, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 2.32, "10th_percentile": 2.32, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 1.04, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.04, "10th_percentile": 1.04, "90th_percentile": 1.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1.04, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.04, "10th_percentile": 1.04, "90th_percentile": 1.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1.04, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.04, "10th_percentile": 1.04, "90th_percentile": 1.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.63, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.63, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1.16, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1.16, "10th_percentile": 1.16, "90th_percentile": 1.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1.16, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1.16, "10th_percentile": 1.16, "90th_percentile": 1.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.54, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1.35, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1.35, "10th_percentile": 1.35, "90th_percentile": 1.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1.62, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1.62, "10th_percentile": 1.62, "90th_percentile": 1.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" } ] } ] }, { "description": "AIRWAY GUEDEL DISPO 60MM", "code_information": [ { "code": "SUP-337765", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 0.2, "maximum": 2.51, "setting": "outpatient", "gross_charge": 2.51, "discounted_cash": 1.76, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.87, "10th_percentile": 1.36, "90th_percentile": 2.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.87, "10th_percentile": 1.36, "90th_percentile": 2.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.87, "10th_percentile": 1.36, "90th_percentile": 2.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.87, "10th_percentile": 1.36, "90th_percentile": 2.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.87, "10th_percentile": 1.36, "90th_percentile": 2.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.87, "10th_percentile": 1.36, "90th_percentile": 2.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.87, "10th_percentile": 1.36, "90th_percentile": 2.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.87, "10th_percentile": 1.36, "90th_percentile": 2.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.87, "10th_percentile": 1.36, "90th_percentile": 2.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.87, "10th_percentile": 1.36, "90th_percentile": 2.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.87, "10th_percentile": 1.36, "90th_percentile": 2.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.87, "10th_percentile": 1.36, "90th_percentile": 2.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.51, "10th_percentile": 2.51, "90th_percentile": 2.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.87, "10th_percentile": 1.36, "90th_percentile": 2.38, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.87, "10th_percentile": 1.36, "90th_percentile": 2.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1.87, "10th_percentile": 1.36, "90th_percentile": 2.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1.87, "10th_percentile": 1.36, "90th_percentile": 2.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 1.13, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.13, "10th_percentile": 1.13, "90th_percentile": 1.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1.13, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.13, "10th_percentile": 1.13, "90th_percentile": 1.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1.13, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.13, "10th_percentile": 1.13, "90th_percentile": 1.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.33, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.51, "10th_percentile": 0.37, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.68, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.51, "10th_percentile": 0.37, "90th_percentile": 0.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.68, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.68, "10th_percentile": 0.68, "90th_percentile": 0.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1.26, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1.26, "10th_percentile": 1.26, "90th_percentile": 1.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1.26, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1.26, "10th_percentile": 1.26, "90th_percentile": 1.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.2, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 0.4, "10th_percentile": 0.24, "90th_percentile": 0.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.59, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 0.4, "10th_percentile": 0.24, "90th_percentile": 0.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1.46, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1.46, "10th_percentile": 1.46, "90th_percentile": 1.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1.76, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1.76, "10th_percentile": 1.76, "90th_percentile": 1.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC SEIU HEALTHLINK", "standard_charge_dollar": 0.47, "standard_charge_percentage": 55.0, "standard_charge_algorithm": "All Services; 55% 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; 55% Billed" } ] } ] }, { "description": "AIRWY MSK FLEX LMA SZ 2.0 DISP", "code_information": [ { "code": "SUP-313720", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 22.6, "maximum": 412.02, "setting": "outpatient", "gross_charge": 83.7, "discounted_cash": 58.59, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 83.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 170.99, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 412.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 83.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 170.99, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 412.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 83.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 170.99, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 412.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 83.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 170.99, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 412.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 83.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 170.99, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 412.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 412.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 170.99, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 83.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 170.99, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 291.5, "10th_percentile": 195.09, "90th_percentile": 387.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 412.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 291.5, "10th_percentile": 195.09, "90th_percentile": 387.92, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 412.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 170.99, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 83.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 83.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 170.99, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 412.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 170.99, "10th_percentile": 101.16, "90th_percentile": 363.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 76.95, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 131.18, "10th_percentile": 87.8, "90th_percentile": 174.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 185.41, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 131.18, "10th_percentile": 87.8, "90th_percentile": 174.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 185.41, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 131.18, "10th_percentile": 87.8, "90th_percentile": 174.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 76.95, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 131.18, "10th_percentile": 87.8, "90th_percentile": 174.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 185.41, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 131.18, "10th_percentile": 87.8, "90th_percentile": 174.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 76.95, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 131.18, "10th_percentile": 87.8, "90th_percentile": 174.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 22.6, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 46.17, "10th_percentile": 27.31, "90th_percentile": 98.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 46.17, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 46.17, "10th_percentile": 27.31, "90th_percentile": 98.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 111.25, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 46.17, "10th_percentile": 27.31, "90th_percentile": 98.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 46.17, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 78.71, "10th_percentile": 52.68, "90th_percentile": 104.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 111.25, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 78.71, "10th_percentile": 52.68, "90th_percentile": 104.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 85.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 145.75, "10th_percentile": 97.55, "90th_percentile": 193.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 206.01, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 145.75, "10th_percentile": 97.55, "90th_percentile": 193.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 85.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 145.75, "10th_percentile": 97.55, "90th_percentile": 193.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 206.01, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 145.75, "10th_percentile": 97.55, "90th_percentile": 193.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 40.01, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 68.21, "10th_percentile": 45.65, "90th_percentile": 90.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 96.41, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 68.21, "10th_percentile": 45.65, "90th_percentile": 90.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 99.17, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 169.07, "10th_percentile": 113.15, "90th_percentile": 224.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 238.97, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 169.07, "10th_percentile": 113.15, "90th_percentile": 224.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 119.69, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 204.05, "10th_percentile": 136.56, "90th_percentile": 271.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 288.41, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 204.05, "10th_percentile": 136.56, "90th_percentile": 271.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" } ] } ] }, { "description": "ALBENDAZOLE 200 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-8979", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "72205-0051-08", "type": "NDC" } ], "standard_charges": [ { "minimum": 6.61, "maximum": 7.63, "setting": "outpatient", "gross_charge": 28.25, "discounted_cash": 19.77, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 7.63, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.63, "10th_percentile": 7.63, "90th_percentile": 7.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 7.63, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.63, "10th_percentile": 7.63, "90th_percentile": 7.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 6.61, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 6.61, "10th_percentile": 6.61, "90th_percentile": 6.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" } ] } ] }, { "description": "ALBUMIN 25% (0.25 G/ML) INJECTION FROM PREMIX (NICU)", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "RX-40808981", "type": "CDM" }, { "code": "P9047", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "76125-0792-25", "type": "NDC" } ], "standard_charges": [ { "minimum": 35.79, "maximum": 184.5, "setting": "outpatient", "gross_charge": 184.5, "discounted_cash": 129.15, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 184.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 184.5, "10th_percentile": 184.5, "90th_percentile": 184.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 184.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 184.5, "10th_percentile": 184.5, "90th_percentile": 184.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 184.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 184.5, "10th_percentile": 184.5, "90th_percentile": 184.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 184.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 184.5, "10th_percentile": 184.5, "90th_percentile": 184.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 184.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 184.5, "10th_percentile": 184.5, "90th_percentile": 184.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 184.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 184.5, "10th_percentile": 184.5, "90th_percentile": 184.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 184.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 184.5, "10th_percentile": 184.5, "90th_percentile": 184.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 83.03, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 83.03, "10th_percentile": 83.03, "90th_percentile": 83.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 49.01, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.41, "10th_percentile": 49.09, "90th_percentile": 49.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 49.82, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.41, "10th_percentile": 49.09, "90th_percentile": 49.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 49.01, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.01, "10th_percentile": 49.01, "90th_percentile": 49.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 92.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 92.25, "10th_percentile": 92.25, "90th_percentile": 92.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 42.47, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 42.47, "10th_percentile": 42.47, "90th_percentile": 42.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 184.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 184.5, "10th_percentile": 184.5, "90th_percentile": 184.5, "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": "NMH HFN/10 PPO", "standard_charge_dollar": 156.83, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 156.83, "10th_percentile": 156.83, "90th_percentile": 156.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 147.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 147.6, "10th_percentile": 147.6, "90th_percentile": 147.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 151.29, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 151.29, "10th_percentile": 151.29, "90th_percentile": 151.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 119.93, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 119.93, "10th_percentile": 119.93, "90th_percentile": 119.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 55.35, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 55.35, "10th_percentile": 55.35, "90th_percentile": 55.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 147.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 147.6, "10th_percentile": 147.6, "90th_percentile": 147.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 92.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 92.25, "10th_percentile": 92.25, "90th_percentile": 92.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 35.79, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 35.79, "10th_percentile": 35.79, "90th_percentile": 35.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 65.13, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "Drugs/Agents ; 35.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 65.13, "10th_percentile": 65.13, "90th_percentile": 65.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents ; 35.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 184.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $184.50 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 184.5, "10th_percentile": 184.5, "90th_percentile": 184.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $184.50 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 184.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 184.5, "10th_percentile": 184.5, "90th_percentile": 184.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 73.8, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 73.8, "10th_percentile": 73.8, "90th_percentile": 73.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 73.8, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 73.8, "10th_percentile": 73.8, "90th_percentile": 73.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 184.5, "10th_percentile": 184.5, "90th_percentile": 184.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 184.5, "10th_percentile": 184.5, "90th_percentile": 184.5, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 184.5, "10th_percentile": 184.5, "90th_percentile": 184.5, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" } ] } ] }, { "description": "ALBUMIN 5% (0.05 G/ML) INJECTION FROM PREMIX (NICU)", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "RX-40808982", "type": "CDM" }, { "code": "P9041", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "68516-5214-06", "type": "NDC" } ], "standard_charges": [ { "minimum": 27.55, "maximum": 142.0, "setting": "outpatient", "gross_charge": 142.0, "discounted_cash": 99.4, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 142.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 142.0, "10th_percentile": 142.0, "90th_percentile": 142.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 142.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 142.0, "10th_percentile": 142.0, "90th_percentile": 142.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 142.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 142.0, "10th_percentile": 142.0, "90th_percentile": 142.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 142.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 142.0, "10th_percentile": 142.0, "90th_percentile": 142.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 142.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 142.0, "10th_percentile": 142.0, "90th_percentile": 142.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 142.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 142.0, "10th_percentile": 142.0, "90th_percentile": 142.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 142.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 142.0, "10th_percentile": 142.0, "90th_percentile": 142.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 63.9, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 63.9, "10th_percentile": 63.9, "90th_percentile": 63.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 38.34, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 38.34, "10th_percentile": 38.34, "90th_percentile": 38.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 71.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 71.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 142.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 142.0, "10th_percentile": 142.0, "90th_percentile": 142.0, "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": "NMH HFN/10 PPO", "standard_charge_dollar": 120.7, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 120.7, "10th_percentile": 120.7, "90th_percentile": 120.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 113.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 113.6, "10th_percentile": 113.6, "90th_percentile": 113.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 116.44, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 116.44, "10th_percentile": 116.44, "90th_percentile": 116.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 92.3, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 92.3, "10th_percentile": 92.3, "90th_percentile": 92.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 42.6, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 42.6, "10th_percentile": 42.6, "90th_percentile": 42.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 113.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 113.6, "10th_percentile": 113.6, "90th_percentile": 113.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 71.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 71.0, "10th_percentile": 71.0, "90th_percentile": 71.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 27.55, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 27.55, "10th_percentile": 27.55, "90th_percentile": 27.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 50.13, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "Drugs/Agents ; 35.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 50.13, "10th_percentile": 50.13, "90th_percentile": 50.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents ; 35.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 142.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $142.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 142.0, "10th_percentile": 142.0, "90th_percentile": 142.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $142.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 142.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 142.0, "10th_percentile": 142.0, "90th_percentile": 142.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 56.8, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 56.8, "10th_percentile": 56.8, "90th_percentile": 56.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 56.8, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 56.8, "10th_percentile": 56.8, "90th_percentile": 56.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 142.0, "10th_percentile": 142.0, "90th_percentile": 142.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 142.0, "10th_percentile": 142.0, "90th_percentile": 142.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 142.0, "10th_percentile": 142.0, "90th_percentile": 142.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" } ] } ] }, { "description": "ALBUMIN, HUMAN 25 % IV SOLP", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "RX-8981", "type": "CDM" }, { "code": "P9047", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00944-0493-02", "type": "NDC" } ], "standard_charges": [ { "minimum": 85.41, "maximum": 1778.5, "setting": "outpatient", "gross_charge": 613.0, "discounted_cash": 429.1, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 613.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1197.25, "10th_percentile": 698.7, "90th_percentile": 1599.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 827.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1197.25, "10th_percentile": 698.7, "90th_percentile": 1599.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1197.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1197.25, "10th_percentile": 698.7, "90th_percentile": 1599.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1331.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1197.25, "10th_percentile": 698.7, "90th_percentile": 1599.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1778.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1197.25, "10th_percentile": 698.7, "90th_percentile": 1599.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1778.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1197.25, "10th_percentile": 698.7, "90th_percentile": 1599.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1331.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1197.25, "10th_percentile": 698.7, "90th_percentile": 1599.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1197.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1197.25, "10th_percentile": 698.7, "90th_percentile": 1599.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 827.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1197.25, "10th_percentile": 698.7, "90th_percentile": 1599.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 613.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1197.25, "10th_percentile": 698.7, "90th_percentile": 1599.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 440.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1012.25, "10th_percentile": 526.63, "90th_percentile": 1554.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 613.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1012.25, "10th_percentile": 526.63, "90th_percentile": 1554.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 827.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1012.25, "10th_percentile": 526.63, "90th_percentile": 1554.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1197.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1012.25, "10th_percentile": 526.63, "90th_percentile": 1554.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1331.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1012.25, "10th_percentile": 526.63, "90th_percentile": 1554.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1778.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 538.76, "10th_percentile": 314.41, "90th_percentile": 719.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 372.26, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 538.76, "10th_percentile": 314.41, "90th_percentile": 719.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 538.76, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 538.76, "10th_percentile": 314.41, "90th_percentile": 719.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 598.95, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 538.76, "10th_percentile": 314.41, "90th_percentile": 719.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 800.33, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 538.76, "10th_percentile": 314.41, "90th_percentile": 719.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 800.33, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 455.51, "10th_percentile": 236.98, "90th_percentile": 699.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 598.95, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 455.51, "10th_percentile": 236.98, "90th_percentile": 699.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 538.76, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 455.51, "10th_percentile": 236.98, "90th_percentile": 699.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 372.26, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 455.51, "10th_percentile": 236.98, "90th_percentile": 699.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 275.85, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 455.51, "10th_percentile": 236.98, "90th_percentile": 699.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 198.11, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 455.51, "10th_percentile": 236.98, "90th_percentile": 699.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 480.2, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 273.31, "10th_percentile": 142.19, "90th_percentile": 419.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 359.37, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 273.31, "10th_percentile": 142.19, "90th_percentile": 419.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 323.26, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 273.31, "10th_percentile": 142.19, "90th_percentile": 419.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 223.36, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 273.31, "10th_percentile": 142.19, "90th_percentile": 419.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 165.51, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 273.31, "10th_percentile": 142.19, "90th_percentile": 419.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 118.87, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 273.31, "10th_percentile": 142.19, "90th_percentile": 419.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 165.51, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 323.26, "10th_percentile": 188.65, "90th_percentile": 431.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 223.36, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 323.26, "10th_percentile": 188.65, "90th_percentile": 431.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 323.26, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 323.26, "10th_percentile": 188.65, "90th_percentile": 431.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 359.37, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 323.26, "10th_percentile": 188.65, "90th_percentile": 431.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 480.2, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 323.26, "10th_percentile": 188.65, "90th_percentile": 431.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 889.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 598.63, "10th_percentile": 349.35, "90th_percentile": 799.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 665.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 598.63, "10th_percentile": 349.35, "90th_percentile": 799.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 598.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 598.63, "10th_percentile": 349.35, "90th_percentile": 799.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 413.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 598.63, "10th_percentile": 349.35, "90th_percentile": 799.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 306.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 598.63, "10th_percentile": 349.35, "90th_percentile": 799.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 220.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 506.13, "10th_percentile": 263.31, "90th_percentile": 777.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 306.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 506.13, "10th_percentile": 263.31, "90th_percentile": 777.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 413.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 506.13, "10th_percentile": 263.31, "90th_percentile": 777.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 598.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 506.13, "10th_percentile": 263.31, "90th_percentile": 777.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 665.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 506.13, "10th_percentile": 263.31, "90th_percentile": 777.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 889.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 506.13, "10th_percentile": 263.31, "90th_percentile": 777.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 143.44, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 280.16, "10th_percentile": 163.5, "90th_percentile": 374.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 193.58, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 280.16, "10th_percentile": 163.5, "90th_percentile": 374.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 280.16, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 280.16, "10th_percentile": 163.5, "90th_percentile": 374.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 311.45, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 280.16, "10th_percentile": 163.5, "90th_percentile": 374.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 416.17, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 280.16, "10th_percentile": 163.5, "90th_percentile": 374.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 429.1, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 838.08, "10th_percentile": 489.09, "90th_percentile": 1119.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 579.08, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 838.08, "10th_percentile": 489.09, "90th_percentile": 1119.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 838.08, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 838.08, "10th_percentile": 489.09, "90th_percentile": 1119.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 931.7, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 838.08, "10th_percentile": 489.09, "90th_percentile": 1119.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1244.95, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 838.08, "10th_percentile": 489.09, "90th_percentile": 1119.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 355.54, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 694.41, "10th_percentile": 405.25, "90th_percentile": 927.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 479.81, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 694.41, "10th_percentile": 405.25, "90th_percentile": 927.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 694.41, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 694.41, "10th_percentile": 405.25, "90th_percentile": 927.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 771.98, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 694.41, "10th_percentile": 405.25, "90th_percentile": 927.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1031.53, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 694.41, "10th_percentile": 405.25, "90th_percentile": 927.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 440.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 440.25, "10th_percentile": 440.25, "90th_percentile": 440.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 374.21, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 374.21, "10th_percentile": 374.21, "90th_percentile": 374.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 352.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 352.2, "10th_percentile": 352.2, "90th_percentile": 352.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 361.01, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 361.01, "10th_percentile": 361.01, "90th_percentile": 361.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 286.16, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 286.16, "10th_percentile": 286.16, "90th_percentile": 286.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 132.08, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 132.08, "10th_percentile": 132.08, "90th_percentile": 132.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 352.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 352.2, "10th_percentile": 352.2, "90th_percentile": 352.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 220.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 220.13, "10th_percentile": 220.13, "90th_percentile": 220.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 85.41, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 85.41, "10th_percentile": 85.41, "90th_percentile": 85.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 155.41, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "Drugs/Agents ; 35.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 155.41, "10th_percentile": 155.41, "90th_percentile": 155.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents ; 35.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 440.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $440.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 440.25, "10th_percentile": 440.25, "90th_percentile": 440.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $440.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 440.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 440.25, "10th_percentile": 440.25, "90th_percentile": 440.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 176.1, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 176.1, "10th_percentile": 176.1, "90th_percentile": 176.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 176.1, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 176.1, "10th_percentile": 176.1, "90th_percentile": 176.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 440.25, "10th_percentile": 440.25, "90th_percentile": 440.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 440.25, "10th_percentile": 440.25, "90th_percentile": 440.25, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 440.25, "10th_percentile": 440.25, "90th_percentile": 440.25, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" } ] } ] }, { "description": "ALBUMIN, HUMAN 25 % IV SOLP", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "RX-8981", "type": "CDM" }, { "code": "P9047", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00944-0493-03", "type": "NDC" } ], "standard_charges": [ { "minimum": 164.74, "maximum": 704.0, "setting": "outpatient", "gross_charge": 704.0, "discounted_cash": 492.8, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 704.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 704.0, "10th_percentile": 704.0, "90th_percentile": 704.0, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 704.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 704.0, "10th_percentile": 704.0, "90th_percentile": 704.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 704.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 704.0, "10th_percentile": 704.0, "90th_percentile": 704.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 704.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 704.0, "10th_percentile": 704.0, "90th_percentile": 704.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 704.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 704.0, "10th_percentile": 704.0, "90th_percentile": 704.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 704.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 704.0, "10th_percentile": 704.0, "90th_percentile": 704.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 704.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 704.0, "10th_percentile": 704.0, "90th_percentile": 704.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 704.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 704.0, "10th_percentile": 704.0, "90th_percentile": 704.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 704.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 704.0, "10th_percentile": 704.0, "90th_percentile": 704.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 316.8, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 316.8, "10th_percentile": 316.8, "90th_percentile": 316.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 316.8, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 316.8, "10th_percentile": 316.8, "90th_percentile": 316.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 316.8, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 316.8, "10th_percentile": 316.8, "90th_percentile": 316.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 190.08, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 190.08, "10th_percentile": 190.08, "90th_percentile": 190.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 190.08, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 190.08, "10th_percentile": 190.08, "90th_percentile": 190.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 352.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 352.0, "10th_percentile": 352.0, "90th_percentile": 352.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 352.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 352.0, "10th_percentile": 352.0, "90th_percentile": 352.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 164.74, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 164.74, "10th_percentile": 164.74, "90th_percentile": 164.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 492.8, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% 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 Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 408.32, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 408.32, "10th_percentile": 408.32, "90th_percentile": 408.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" } ] } ] }, { "description": "ALBUMIN, HUMAN 25 % IV SOLP", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "RX-8981", "type": "CDM" }, { "code": "P9047", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "44206-0251-10", "type": "NDC" } ], "standard_charges": [ { "minimum": 78.47, "maximum": 1634.25, "setting": "outpatient", "gross_charge": 760.0, "discounted_cash": 532.0, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 760.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1197.13, "10th_percentile": 847.43, "90th_percentile": 1546.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1634.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1197.13, "10th_percentile": 847.43, "90th_percentile": 1546.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 760.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1197.13, "10th_percentile": 847.43, "90th_percentile": 1546.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1634.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1197.13, "10th_percentile": 847.43, "90th_percentile": 1546.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1634.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 760.0, "10th_percentile": 475.6, "90th_percentile": 1459.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 760.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 760.0, "10th_percentile": 475.6, "90th_percentile": 1459.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 404.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 760.0, "10th_percentile": 475.6, "90th_percentile": 1459.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 404.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 760.0, "10th_percentile": 475.6, "90th_percentile": 1459.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 760.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 760.0, "10th_percentile": 475.6, "90th_percentile": 1459.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1634.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 760.0, "10th_percentile": 475.6, "90th_percentile": 1459.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 404.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 760.0, "10th_percentile": 475.6, "90th_percentile": 1459.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 760.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 760.0, "10th_percentile": 475.6, "90th_percentile": 1459.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1634.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 760.0, "10th_percentile": 475.6, "90th_percentile": 1459.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1634.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 760.0, "10th_percentile": 475.6, "90th_percentile": 1459.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 760.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 760.0, "10th_percentile": 475.6, "90th_percentile": 1459.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 404.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 760.0, "10th_percentile": 475.6, "90th_percentile": 1459.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1634.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 760.0, "10th_percentile": 475.6, "90th_percentile": 1459.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 760.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 760.0, "10th_percentile": 475.6, "90th_percentile": 1459.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 404.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 760.0, "10th_percentile": 475.6, "90th_percentile": 1459.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 404.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 760.0, "10th_percentile": 475.6, "90th_percentile": 1459.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 760.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 760.0, "10th_percentile": 475.6, "90th_percentile": 1459.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1634.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 760.0, "10th_percentile": 475.6, "90th_percentile": 1459.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 404.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 760.0, "10th_percentile": 475.6, "90th_percentile": 1459.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 760.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 760.0, "10th_percentile": 475.6, "90th_percentile": 1459.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1634.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 760.0, "10th_percentile": 475.6, "90th_percentile": 1459.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 342.0, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 538.7, "10th_percentile": 381.34, "90th_percentile": 696.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 735.41, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 538.7, "10th_percentile": 381.34, "90th_percentile": 696.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 342.0, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 538.7, "10th_percentile": 381.34, "90th_percentile": 696.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 735.41, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 538.7, "10th_percentile": 381.34, "90th_percentile": 696.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 735.41, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 342.0, "10th_percentile": 214.02, "90th_percentile": 656.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 342.0, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 342.0, "10th_percentile": 214.02, "90th_percentile": 656.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 182.03, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 342.0, "10th_percentile": 214.02, "90th_percentile": 656.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 109.22, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 205.2, "10th_percentile": 128.42, "90th_percentile": 394.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 205.2, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 205.2, "10th_percentile": 128.42, "90th_percentile": 394.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 441.25, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 205.2, "10th_percentile": 128.42, "90th_percentile": 394.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 205.2, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 323.23, "10th_percentile": 228.81, "90th_percentile": 417.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 441.25, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 323.23, "10th_percentile": 228.81, "90th_percentile": 417.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 380.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 598.57, "10th_percentile": 423.71, "90th_percentile": 773.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 817.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 598.57, "10th_percentile": 423.71, "90th_percentile": 773.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 202.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 380.0, "10th_percentile": 237.8, "90th_percentile": 729.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 380.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 380.0, "10th_percentile": 237.8, "90th_percentile": 729.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 817.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 380.0, "10th_percentile": 237.8, "90th_percentile": 729.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 177.84, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 280.13, "10th_percentile": 198.3, "90th_percentile": 361.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 382.41, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 280.13, "10th_percentile": 198.3, "90th_percentile": 361.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 532.0, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 837.99, "10th_percentile": 593.2, "90th_percentile": 1082.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1143.98, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 837.99, "10th_percentile": 593.2, "90th_percentile": 1082.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 440.8, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 694.34, "10th_percentile": 491.51, "90th_percentile": 897.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 947.87, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 694.34, "10th_percentile": 491.51, "90th_percentile": 897.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 404.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 404.5, "10th_percentile": 404.5, "90th_percentile": 404.5, "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": "NMH HFN/10 PPO", "standard_charge_dollar": 343.83, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 343.83, "10th_percentile": 343.83, "90th_percentile": 343.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 323.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 323.6, "10th_percentile": 323.6, "90th_percentile": 323.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 331.69, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 331.69, "10th_percentile": 331.69, "90th_percentile": 331.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 262.93, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 262.93, "10th_percentile": 262.93, "90th_percentile": 262.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 121.35, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 121.35, "10th_percentile": 121.35, "90th_percentile": 121.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 323.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 323.6, "10th_percentile": 323.6, "90th_percentile": 323.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 202.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 202.25, "10th_percentile": 202.25, "90th_percentile": 202.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 78.47, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 78.47, "10th_percentile": 78.47, "90th_percentile": 78.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 142.79, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "Drugs/Agents ; 35.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 142.79, "10th_percentile": 142.79, "90th_percentile": 142.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents ; 35.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 404.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $404.50 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 404.5, "10th_percentile": 404.5, "90th_percentile": 404.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $404.50 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 404.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 404.5, "10th_percentile": 404.5, "90th_percentile": 404.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 161.8, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 161.8, "10th_percentile": 161.8, "90th_percentile": 161.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 161.8, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 161.8, "10th_percentile": 161.8, "90th_percentile": 161.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 404.5, "10th_percentile": 404.5, "90th_percentile": 404.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 404.5, "10th_percentile": 404.5, "90th_percentile": 404.5, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 404.5, "10th_percentile": 404.5, "90th_percentile": 404.5, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" } ] } ] }, { "description": "ALBUMIN, HUMAN 25 % IV SOLP", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "RX-8981", "type": "CDM" }, { "code": "P9047", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "68516-5216-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 43.17, "maximum": 757.25, "setting": "outpatient", "gross_charge": 211.5, "discounted_cash": 148.05, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 211.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 211.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 211.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 211.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 211.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 211.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 211.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 757.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 757.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 757.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 757.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 633.5, "10th_percentile": 534.5, "90th_percentile": 732.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 757.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 757.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 757.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 757.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 509.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 509.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 509.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 509.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 633.5, "10th_percentile": 534.5, "90th_percentile": 732.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 509.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 509.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 509.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 509.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 211.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 509.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 757.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 509.75, "10th_percentile": 271.15, "90th_percentile": 707.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 229.39, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 285.07, "10th_percentile": 240.53, "90th_percentile": 329.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 340.76, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 285.07, "10th_percentile": 240.53, "90th_percentile": 329.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 229.39, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 285.07, "10th_percentile": 240.53, "90th_percentile": 329.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 340.76, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 285.07, "10th_percentile": 240.53, "90th_percentile": 329.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 229.39, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 285.07, "10th_percentile": 240.53, "90th_percentile": 329.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 340.76, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 285.07, "10th_percentile": 240.53, "90th_percentile": 329.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 49.82, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.37, "10th_percentile": 52.01, "90th_percentile": 184.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 57.11, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.37, "10th_percentile": 52.01, "90th_percentile": 184.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 137.63, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.37, "10th_percentile": 52.01, "90th_percentile": 184.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 204.46, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.37, "10th_percentile": 52.01, "90th_percentile": 184.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 204.46, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 137.63, "10th_percentile": 67.38, "90th_percentile": 191.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 137.63, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 137.63, "10th_percentile": 67.38, "90th_percentile": 191.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 49.82, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 137.63, "10th_percentile": 67.38, "90th_percentile": 191.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 254.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 316.75, "10th_percentile": 267.25, "90th_percentile": 366.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 378.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 316.75, "10th_percentile": 267.25, "90th_percentile": 366.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 254.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 316.75, "10th_percentile": 267.25, "90th_percentile": 366.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 378.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 316.75, "10th_percentile": 267.25, "90th_percentile": 366.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 43.17, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 119.28, "10th_percentile": 58.39, "90th_percentile": 165.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 119.28, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 119.28, "10th_percentile": 58.39, "90th_percentile": 165.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 177.2, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 119.28, "10th_percentile": 58.39, "90th_percentile": 165.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 356.83, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 443.46, "10th_percentile": 374.15, "90th_percentile": 512.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 530.08, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 443.46, "10th_percentile": 374.15, "90th_percentile": 512.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 295.66, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 367.44, "10th_percentile": 310.02, "90th_percentile": 424.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 439.21, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 367.44, "10th_percentile": 310.02, "90th_percentile": 424.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" } ] } ] }, { "description": "ALBUMIN, HUMAN 25 % IV SOLP", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "RX-8981", "type": "CDM" }, { "code": "P9047", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "68516-5216-07", "type": "NDC" } ], "standard_charges": [ { "minimum": 126.77, "maximum": 805.0, "setting": "outpatient", "gross_charge": 805.0, "discounted_cash": 563.5, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 805.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 673.38, "10th_percentile": 568.08, "90th_percentile": 778.67, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 805.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 673.38, "10th_percentile": 568.08, "90th_percentile": 778.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 805.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 673.38, "10th_percentile": 568.08, "90th_percentile": 778.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 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100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 541.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 673.38, "10th_percentile": 568.08, "90th_percentile": 778.67, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 541.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 673.38, "10th_percentile": 568.08, "90th_percentile": 778.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 541.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 673.38, "10th_percentile": 568.08, "90th_percentile": 778.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 541.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 673.38, "10th_percentile": 568.08, "90th_percentile": 778.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 541.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 673.38, "10th_percentile": 568.08, "90th_percentile": 778.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 541.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 673.38, "10th_percentile": 568.08, "90th_percentile": 778.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 541.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 673.38, "10th_percentile": 568.08, "90th_percentile": 778.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 541.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 673.38, "10th_percentile": 568.08, "90th_percentile": 778.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 541.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 673.38, "10th_percentile": 568.08, "90th_percentile": 778.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 805.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 673.38, "10th_percentile": 568.08, "90th_percentile": 778.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 362.25, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 303.02, "10th_percentile": 255.64, "90th_percentile": 350.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 243.79, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 303.02, "10th_percentile": 255.64, "90th_percentile": 350.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 243.79, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 303.02, "10th_percentile": 255.64, "90th_percentile": 350.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 362.25, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 303.02, "10th_percentile": 255.64, "90th_percentile": 350.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 243.79, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 303.02, "10th_percentile": 255.64, "90th_percentile": 350.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 362.25, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 303.02, "10th_percentile": 255.64, "90th_percentile": 350.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 146.27, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.81, "10th_percentile": 153.38, "90th_percentile": 210.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 217.35, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.81, "10th_percentile": 153.38, "90th_percentile": 210.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 146.27, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.81, "10th_percentile": 153.38, "90th_percentile": 210.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 217.35, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.81, "10th_percentile": 153.38, "90th_percentile": 210.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 402.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 336.69, "10th_percentile": 284.04, "90th_percentile": 389.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 270.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 336.69, "10th_percentile": 284.04, "90th_percentile": 389.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 270.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 336.69, "10th_percentile": 284.04, "90th_percentile": 389.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 402.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 336.69, "10th_percentile": 284.04, "90th_percentile": 389.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 126.77, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 157.57, "10th_percentile": 132.93, "90th_percentile": 182.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 188.37, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 157.57, "10th_percentile": 132.93, "90th_percentile": 182.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 379.23, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 471.37, "10th_percentile": 397.66, "90th_percentile": 545.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 563.5, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 471.37, "10th_percentile": 397.66, "90th_percentile": 545.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 314.22, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 390.56, "10th_percentile": 329.49, "90th_percentile": 451.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 466.9, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 390.56, "10th_percentile": 329.49, "90th_percentile": 451.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" } ] } ] }, { "description": "ALBUMIN, HUMAN 25 % IV SOLP", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "RX-8981", "type": "CDM" }, { "code": "P9047", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "76125-0792-10", "type": "NDC" } ], "standard_charges": [ { "minimum": 71.54, "maximum": 693.0, "setting": "outpatient", "gross_charge": 693.0, "discounted_cash": 485.1, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 693.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 530.88, "10th_percentile": 401.18, "90th_percentile": 660.57, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 693.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 368.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 530.88, "10th_percentile": 401.18, "90th_percentile": 660.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 693.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 530.88, "10th_percentile": 401.18, "90th_percentile": 660.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 311.85, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 311.85, "10th_percentile": 311.85, "90th_percentile": 311.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 311.85, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 311.85, "10th_percentile": 311.85, "90th_percentile": 311.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 165.94, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 238.9, "10th_percentile": 180.53, "90th_percentile": 297.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 311.85, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 238.9, "10th_percentile": 180.53, "90th_percentile": 297.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 99.56, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 143.34, "10th_percentile": 108.32, "90th_percentile": 178.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 187.11, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 143.34, "10th_percentile": 108.32, "90th_percentile": 178.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 187.11, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 187.11, "10th_percentile": 187.11, "90th_percentile": 187.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 346.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 346.5, "10th_percentile": 346.5, "90th_percentile": 346.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 184.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 265.44, "10th_percentile": 200.59, "90th_percentile": 330.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 346.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 265.44, "10th_percentile": 200.59, "90th_percentile": 330.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 162.16, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 162.16, "10th_percentile": 162.16, "90th_percentile": 162.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 485.1, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 485.1, "10th_percentile": 485.1, "90th_percentile": 485.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 401.94, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 401.94, "10th_percentile": 401.94, "90th_percentile": 401.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 368.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 368.75, "10th_percentile": 368.75, "90th_percentile": 368.75, "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": "NMH HFN/10 PPO", "standard_charge_dollar": 313.44, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 313.44, "10th_percentile": 313.44, "90th_percentile": 313.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 295.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 295.0, "10th_percentile": 295.0, "90th_percentile": 295.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 302.38, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 302.38, "10th_percentile": 302.38, "90th_percentile": 302.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 239.69, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 239.69, "10th_percentile": 239.69, "90th_percentile": 239.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 110.63, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 110.63, "10th_percentile": 110.63, "90th_percentile": 110.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 295.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 295.0, "10th_percentile": 295.0, "90th_percentile": 295.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 184.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 184.38, "10th_percentile": 184.38, "90th_percentile": 184.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 71.54, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 71.54, "10th_percentile": 71.54, "90th_percentile": 71.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 130.17, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "Drugs/Agents ; 35.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 130.17, "10th_percentile": 130.17, "90th_percentile": 130.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents ; 35.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 368.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $368.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 368.75, "10th_percentile": 368.75, "90th_percentile": 368.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $368.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 368.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 368.75, "10th_percentile": 368.75, "90th_percentile": 368.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 147.5, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 147.5, "10th_percentile": 147.5, "90th_percentile": 147.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 147.5, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 147.5, "10th_percentile": 147.5, "90th_percentile": 147.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 368.75, "10th_percentile": 368.75, "90th_percentile": 368.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 368.75, "10th_percentile": 368.75, "90th_percentile": 368.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 368.75, "10th_percentile": 368.75, "90th_percentile": 368.75, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" } ] } ] }, { "description": "ALBUMIN, HUMAN 5 % IV SOLP", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "RX-8982", "type": "CDM" }, { "code": "P9045", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "68516-5219-02", "type": "NDC" } ], "standard_charges": [ { "minimum": 377.85, "maximum": 1614.75, "setting": "outpatient", "gross_charge": 1614.75, "discounted_cash": 1130.32, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1614.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1614.75, "10th_percentile": 1614.75, "90th_percentile": 1614.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1614.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1614.75, "10th_percentile": 1614.75, "90th_percentile": 1614.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1614.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1614.75, "10th_percentile": 1614.75, "90th_percentile": 1614.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1614.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1614.75, "10th_percentile": 1614.75, "90th_percentile": 1614.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1614.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1614.75, "10th_percentile": 1614.75, "90th_percentile": 1614.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1614.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1614.75, "10th_percentile": 1614.75, "90th_percentile": 1614.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1614.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1614.75, "10th_percentile": 1614.75, "90th_percentile": 1614.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1614.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1614.75, "10th_percentile": 1614.75, "90th_percentile": 1614.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1614.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1614.75, "10th_percentile": 1614.75, "90th_percentile": 1614.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 726.64, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 726.64, "10th_percentile": 726.64, "90th_percentile": 726.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 726.64, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 726.64, "10th_percentile": 726.64, "90th_percentile": 726.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 726.64, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 726.64, "10th_percentile": 726.64, "90th_percentile": 726.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 435.98, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 435.98, "10th_percentile": 435.98, "90th_percentile": 435.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 435.98, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 435.98, "10th_percentile": 435.98, "90th_percentile": 435.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 807.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 807.38, "10th_percentile": 807.38, "90th_percentile": 807.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 807.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 807.38, "10th_percentile": 807.38, "90th_percentile": 807.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 377.85, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 377.85, "10th_percentile": 377.85, "90th_percentile": 377.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1130.33, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 1130.33, "10th_percentile": 1130.33, "90th_percentile": 1130.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 936.56, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 936.56, "10th_percentile": 936.56, "90th_percentile": 936.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" } ] } ] }, { "description": "ALBUMIN, HUMAN 5 % IV SOLP", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "RX-8982", "type": "CDM" }, { "code": "P9045", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "68982-0623-03", "type": "NDC" } ], "standard_charges": [ { "minimum": 89.87, "maximum": 1871.5, "setting": "outpatient", "gross_charge": 463.25, "discounted_cash": 324.27, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 463.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 522.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 522.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 870.5, "10th_percentile": 592.1, "90th_percentile": 1671.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 522.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 463.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 463.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 522.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 463.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 522.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 522.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 463.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 522.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 463.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1871.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1871.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 870.5, "10th_percentile": 592.1, "90th_percentile": 1671.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1871.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1871.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1371.0, "10th_percentile": 970.6, "90th_percentile": 1771.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1871.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1871.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1871.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1871.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 870.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 870.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 870.5, "10th_percentile": 592.1, "90th_percentile": 1671.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 870.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 870.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1371.0, "10th_percentile": 970.6, "90th_percentile": 1771.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 870.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 870.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 870.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 870.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1871.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 870.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 522.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 463.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 696.5, "10th_percentile": 481.02, "90th_percentile": 1571.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 391.73, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 616.95, "10th_percentile": 436.78, "90th_percentile": 797.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 842.18, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 616.95, "10th_percentile": 436.78, "90th_percentile": 797.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 391.73, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 616.95, "10th_percentile": 436.78, "90th_percentile": 797.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 842.18, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 616.95, "10th_percentile": 436.78, "90th_percentile": 797.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 208.46, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 391.73, "10th_percentile": 245.11, "90th_percentile": 752.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 391.73, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 391.73, "10th_percentile": 245.11, "90th_percentile": 752.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 842.18, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 391.73, "10th_percentile": 245.11, "90th_percentile": 752.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 125.08, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 188.06, "10th_percentile": 129.88, "90th_percentile": 424.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 141.08, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 188.06, "10th_percentile": 129.88, "90th_percentile": 424.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 235.04, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 188.06, "10th_percentile": 129.88, "90th_percentile": 424.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 505.31, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 188.06, "10th_percentile": 129.88, "90th_percentile": 424.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 235.04, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 370.18, "10th_percentile": 262.07, "90th_percentile": 478.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 505.31, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 370.18, "10th_percentile": 262.07, "90th_percentile": 478.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 435.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 685.5, "10th_percentile": 485.3, "90th_percentile": 885.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 935.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 685.5, "10th_percentile": 485.3, "90th_percentile": 885.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 231.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 435.25, "10th_percentile": 272.35, "90th_percentile": 835.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 435.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 435.25, "10th_percentile": 272.35, "90th_percentile": 835.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 935.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 435.25, "10th_percentile": 272.35, "90th_percentile": 835.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 203.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 320.81, "10th_percentile": 227.12, "90th_percentile": 414.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 437.93, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 320.81, "10th_percentile": 227.12, "90th_percentile": 414.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 609.35, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 959.7, "10th_percentile": 679.42, "90th_percentile": 1239.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1310.05, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 959.7, "10th_percentile": 679.42, "90th_percentile": 1239.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 504.89, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 795.18, "10th_percentile": 562.95, "90th_percentile": 1027.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1085.47, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 795.18, "10th_percentile": 562.95, "90th_percentile": 1027.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 463.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 463.25, "10th_percentile": 463.25, "90th_percentile": 463.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 393.76, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 393.76, "10th_percentile": 393.76, "90th_percentile": 393.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 370.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 370.6, "10th_percentile": 370.6, "90th_percentile": 370.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 379.87, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 379.87, "10th_percentile": 379.87, "90th_percentile": 379.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 301.11, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 301.11, "10th_percentile": 301.11, "90th_percentile": 301.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 138.98, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 138.98, "10th_percentile": 138.98, "90th_percentile": 138.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 370.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 370.6, "10th_percentile": 370.6, "90th_percentile": 370.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 231.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 231.63, "10th_percentile": 231.63, "90th_percentile": 231.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 89.87, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 89.87, "10th_percentile": 89.87, "90th_percentile": 89.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 163.53, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "Drugs/Agents ; 35.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 163.53, "10th_percentile": 163.53, "90th_percentile": 163.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents ; 35.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 463.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $463.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 463.25, "10th_percentile": 463.25, "90th_percentile": 463.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $463.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 463.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 463.25, "10th_percentile": 463.25, "90th_percentile": 463.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 185.3, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 185.3, "10th_percentile": 185.3, "90th_percentile": 185.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 185.3, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 185.3, "10th_percentile": 185.3, "90th_percentile": 185.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 463.25, "10th_percentile": 463.25, "90th_percentile": 463.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 463.25, "10th_percentile": 463.25, "90th_percentile": 463.25, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 463.25, "10th_percentile": 463.25, "90th_percentile": 463.25, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" } ] } ] }, { "description": "ALBUMIN, HUMAN-KJDA 25 % 25 % IV SOLN", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "RX-217245", "type": "CDM" }, { "code": "P9047", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "64208-2512-03", "type": "NDC" } ], "standard_charges": [ { "minimum": 115.42, "maximum": 548.5, "setting": "outpatient", "gross_charge": 493.25, "discounted_cash": 345.27, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 493.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 520.88, "10th_percentile": 498.77, "90th_percentile": 542.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 548.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 520.88, "10th_percentile": 498.77, "90th_percentile": 542.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 493.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 520.88, "10th_percentile": 498.77, "90th_percentile": 542.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 548.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 520.88, "10th_percentile": 498.77, "90th_percentile": 542.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 493.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 520.88, "10th_percentile": 498.77, "90th_percentile": 542.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 548.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 520.88, "10th_percentile": 498.77, "90th_percentile": 542.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 493.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 520.88, "10th_percentile": 498.77, "90th_percentile": 542.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 548.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 520.88, "10th_percentile": 498.77, "90th_percentile": 542.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 493.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 520.88, "10th_percentile": 498.77, "90th_percentile": 542.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 548.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 520.88, "10th_percentile": 498.77, "90th_percentile": 542.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 493.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 520.88, "10th_percentile": 498.77, "90th_percentile": 542.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 548.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 520.88, "10th_percentile": 498.77, "90th_percentile": 542.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 493.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 520.88, "10th_percentile": 498.77, "90th_percentile": 542.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 548.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 520.88, "10th_percentile": 498.77, "90th_percentile": 542.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 493.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 520.88, "10th_percentile": 498.77, "90th_percentile": 542.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 548.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 520.88, "10th_percentile": 498.77, "90th_percentile": 542.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 548.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 520.88, "10th_percentile": 498.77, "90th_percentile": 542.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 493.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 520.88, "10th_percentile": 498.77, "90th_percentile": 542.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 221.96, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 234.4, "10th_percentile": 224.45, "90th_percentile": 244.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 246.83, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 234.4, "10th_percentile": 224.45, "90th_percentile": 244.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 221.96, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 234.4, "10th_percentile": 224.45, "90th_percentile": 244.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 246.83, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 234.4, "10th_percentile": 224.45, "90th_percentile": 244.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 221.96, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 234.4, "10th_percentile": 224.45, "90th_percentile": 244.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 246.83, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 234.4, "10th_percentile": 224.45, "90th_percentile": 244.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 133.18, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 140.64, "10th_percentile": 134.67, "90th_percentile": 146.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 148.1, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 140.64, "10th_percentile": 134.67, "90th_percentile": 146.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 133.18, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 140.64, "10th_percentile": 134.67, "90th_percentile": 146.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 148.1, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 140.64, "10th_percentile": 134.67, "90th_percentile": 146.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 246.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 260.44, "10th_percentile": 249.39, "90th_percentile": 271.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 274.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 260.44, "10th_percentile": 249.39, "90th_percentile": 271.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 246.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 260.44, "10th_percentile": 249.39, "90th_percentile": 271.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 274.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 260.44, "10th_percentile": 249.39, "90th_percentile": 271.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 115.42, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 121.88, "10th_percentile": 116.71, "90th_percentile": 127.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 128.35, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 121.88, "10th_percentile": 116.71, "90th_percentile": 127.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 383.95, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 364.62, "10th_percentile": 349.15, "90th_percentile": 380.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 345.28, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 364.62, "10th_percentile": 349.15, "90th_percentile": 380.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 286.09, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 302.11, "10th_percentile": 289.29, "90th_percentile": 314.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 318.13, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 302.11, "10th_percentile": 289.29, "90th_percentile": 314.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" } ] } ] }, { "description": "ALBUTEROL SULFATE 1.25 MG/3 ML INH NEBU", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "RX-31578", "type": "CDM" }, { "code": "25000000", "type": "LOCAL" }, { "code": "0250", "type": "RC" }, { "code": "76204-0011-05", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.95, "maximum": 22.5, "setting": "outpatient", "gross_charge": 3.5, "discounted_cash": 2.45, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.0, "10th_percentile": 5.4, "90th_percentile": 20.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed", "median_amount": 13.0, "10th_percentile": 5.4, "90th_percentile": 20.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 22.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.0, "10th_percentile": 5.4, "90th_percentile": 20.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 22.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.0, "10th_percentile": 5.4, "90th_percentile": 20.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 22.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.0, "10th_percentile": 5.4, "90th_percentile": 20.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 22.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.0, "10th_percentile": 5.4, "90th_percentile": 20.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 22.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.0, "10th_percentile": 5.4, "90th_percentile": 20.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 22.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.0, "10th_percentile": 5.4, "90th_percentile": 20.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 22.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13.0, "10th_percentile": 5.4, "90th_percentile": 20.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 22.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.5, "10th_percentile": 22.5, "90th_percentile": 22.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 22.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 13.0, "10th_percentile": 5.4, "90th_percentile": 20.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 3.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 13.0, "10th_percentile": 5.4, "90th_percentile": 20.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 10.13, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 10.13, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 10.13, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 6.08, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 6.08, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.52, "10th_percentile": 1.46, "90th_percentile": 5.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.95, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.52, "10th_percentile": 1.46, "90th_percentile": 5.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 11.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% 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 Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 11.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% 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 Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 5.27, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 5.27, "10th_percentile": 5.27, "90th_percentile": 5.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 15.75, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 15.75, "10th_percentile": 15.75, "90th_percentile": 15.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 13.05, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 13.05, "10th_percentile": 13.05, "90th_percentile": 13.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" } ] } ] }, { "description": "ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INH NEBU", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "RX-250", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0250", "type": "RC" }, { "code": "00487-9501-25", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.35, "maximum": 5.5, "setting": "outpatient", "gross_charge": 5.5, "discounted_cash": 3.85, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 5.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.49, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.44, "90th_percentile": 1.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 2.48, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2.48, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 2.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1.29, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 0.47, "10th_percentile": 0.37, "90th_percentile": 1.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 3.19, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 3.19, "10th_percentile": 3.19, "90th_percentile": 3.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2.48, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 2.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.49, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.44, "90th_percentile": 1.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 3.85, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 3.85, "10th_percentile": 3.85, "90th_percentile": 3.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.44, "90th_percentile": 1.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.44, "90th_percentile": 1.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.47, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 0.47, "10th_percentile": 0.37, "90th_percentile": 1.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" } ] } ] }, { "description": "ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INH NEBU", "drug_information": { "unit": 1.5, "type": "ML" }, "code_information": [ { "code": "RX-250", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0250", "type": "RC" }, { "code": "76204-0200-25", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.12, "maximum": 4.5, "setting": "outpatient", "gross_charge": 4.5, "discounted_cash": 3.15, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.13, "10th_percentile": 1.13, "90th_percentile": 3.83, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.13, "10th_percentile": 1.13, "90th_percentile": 3.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.13, "10th_percentile": 1.13, "90th_percentile": 3.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.13, "10th_percentile": 1.13, "90th_percentile": 3.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.13, "10th_percentile": 1.13, "90th_percentile": 3.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.13, "10th_percentile": 1.13, "90th_percentile": 3.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.13, "10th_percentile": 1.13, "90th_percentile": 3.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 2.13, "10th_percentile": 1.13, "90th_percentile": 3.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3.38, "10th_percentile": 2.48, "90th_percentile": 4.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.22, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.17, "90th_percentile": 0.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 2.03, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.52, "10th_percentile": 1.11, "90th_percentile": 1.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2.03, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.52, "10th_percentile": 1.11, "90th_percentile": 1.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1.69, "10th_percentile": 1.24, "90th_percentile": 2.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1.05, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 0.5, "10th_percentile": 0.23, "90th_percentile": 0.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 2.61, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1.96, "10th_percentile": 1.44, "90th_percentile": 2.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2.03, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.52, "10th_percentile": 1.11, "90th_percentile": 1.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 1.69, "10th_percentile": 1.24, "90th_percentile": 2.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.22, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.57, "10th_percentile": 0.26, "90th_percentile": 1.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 3.15, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 2.37, "10th_percentile": 1.74, "90th_percentile": 2.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.13, "10th_percentile": 1.13, "90th_percentile": 3.83, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.13, "10th_percentile": 1.13, "90th_percentile": 3.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.13, "10th_percentile": 1.13, "90th_percentile": 3.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.13, "10th_percentile": 1.13, "90th_percentile": 3.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.13, "10th_percentile": 1.13, "90th_percentile": 3.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.13, "10th_percentile": 1.13, "90th_percentile": 3.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.13, "10th_percentile": 1.13, "90th_percentile": 3.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 2.13, "10th_percentile": 1.13, "90th_percentile": 3.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.17, "90th_percentile": 0.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.17, "90th_percentile": 0.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.57, "10th_percentile": 0.26, "90th_percentile": 1.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.47, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 0.5, "10th_percentile": 0.23, "90th_percentile": 0.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" } ] } ] }, { "description": "ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INH NEBU|DISCARDED DRUG NOT ADMINISTE", "drug_information": { "unit": 1.5, "type": "ML" }, "code_information": [ { "code": "RX-250", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0250", "type": "RC" }, { "code": "00378-8270-52", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.18, "maximum": 7.0, "setting": "outpatient", "gross_charge": 0.75, "discounted_cash": 0.52, "payers_information": [ { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.18, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 0.47, "10th_percentile": 0.24, "90th_percentile": 1.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.2, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.27, "90th_percentile": 1.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.2, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.54, "10th_percentile": 0.27, "90th_percentile": 1.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INH NEBU|DISCARDED DRUG NOT ADMINISTE", "drug_information": { "unit": 1.5, "type": "ML" }, "code_information": [ { "code": "RX-250", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0250", "type": "RC" }, { "code": "00378-8270-62", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.18, "maximum": 0.54, "setting": "outpatient", "gross_charge": 0.75, "discounted_cash": 0.52, "payers_information": [ { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.18, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 0.32, "10th_percentile": 0.21, "90th_percentile": 0.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.2, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.37, "10th_percentile": 0.23, "90th_percentile": 0.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.2, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.37, "10th_percentile": 0.23, "90th_percentile": 0.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INH NEBU|DISCARDED DRUG NOT ADMINISTE", "drug_information": { "unit": 1.5, "type": "ML" }, "code_information": [ { "code": "RX-250", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0250", "type": "RC" }, { "code": "00378-8270-93", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.18, "maximum": 2.0, "setting": "outpatient", "gross_charge": 1.0, "discounted_cash": 0.7, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.27, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.41, "10th_percentile": 0.22, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.5, "10th_percentile": 1.1, "90th_percentile": 1.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.5, "10th_percentile": 1.1, "90th_percentile": 1.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.5, "10th_percentile": 1.1, "90th_percentile": 1.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.5, "10th_percentile": 1.1, "90th_percentile": 1.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.5, "10th_percentile": 1.1, "90th_percentile": 1.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.5, "10th_percentile": 1.1, "90th_percentile": 1.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1.5, "10th_percentile": 1.1, "90th_percentile": 1.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 1.5, "10th_percentile": 1.1, "90th_percentile": 1.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.18, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 0.32, "10th_percentile": 0.21, "90th_percentile": 0.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.2, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.41, "10th_percentile": 0.22, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.2, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.37, "10th_percentile": 0.23, "90th_percentile": 0.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "ALBUTEROL SULFATE 2.5 MG /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": 0.35, "maximum": 12.0, "setting": "outpatient", "gross_charge": 1.5, "discounted_cash": 1.05, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.38, "10th_percentile": 1.65, "90th_percentile": 11.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.38, "10th_percentile": 1.65, "90th_percentile": 11.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.38, "10th_percentile": 1.65, "90th_percentile": 11.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.38, "10th_percentile": 1.65, "90th_percentile": 11.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.38, "10th_percentile": 1.65, "90th_percentile": 11.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.38, "10th_percentile": 1.65, "90th_percentile": 11.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.38, "10th_percentile": 1.65, "90th_percentile": 11.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 1.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.38, "10th_percentile": 1.65, "90th_percentile": 11.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 1.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 6.38, "10th_percentile": 1.65, "90th_percentile": 11.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.41, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.72, "10th_percentile": 0.45, "90th_percentile": 3.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.41, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.72, "10th_percentile": 0.45, "90th_percentile": 3.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 0.68, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.87, "10th_percentile": 0.75, "90th_percentile": 5.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 0.68, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.87, "10th_percentile": 0.75, "90th_percentile": 5.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 0.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3.19, "10th_percentile": 0.82, "90th_percentile": 5.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.35, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 0.76, "10th_percentile": 0.41, "90th_percentile": 2.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 0.87, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1.88, "10th_percentile": 1.01, "90th_percentile": 6.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 0.68, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.87, "10th_percentile": 0.75, "90th_percentile": 5.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 0.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3.19, "10th_percentile": 0.82, "90th_percentile": 5.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1.05, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 2.27, "10th_percentile": 1.23, "90th_percentile": 7.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.59, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 0.76, "10th_percentile": 0.41, "90th_percentile": 2.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 1.45, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 1.88, "10th_percentile": 1.01, "90th_percentile": 6.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 1.75, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 2.27, "10th_percentile": 1.23, "90th_percentile": 7.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" } ] } ] }, { "description": "ALBUTEROL SULFATE 2.5 MG/0.5 ML INH NEBU", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-97580", "type": "CDM" }, { "code": "25000000", "type": "LOCAL" }, { "code": "0250", "type": "RC" }, { "code": "00487-9901-30", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.58, "maximum": 33.75, "setting": "outpatient", "gross_charge": 3.25, "discounted_cash": 2.27, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 16.38, "10th_percentile": 3.63, "90th_percentile": 32.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 3.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 16.38, "10th_percentile": 3.63, "90th_percentile": 32.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 21.25, "10th_percentile": 7.0, "90th_percentile": 32.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 11.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 11.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 21.25, "10th_percentile": 7.0, "90th_percentile": 32.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 11.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 11.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 21.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 21.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 21.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 30.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 30.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 21.25, "10th_percentile": 7.0, "90th_percentile": 32.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 30.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 33.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 33.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 33.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 21.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 30.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 33.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 11.5, "10th_percentile": 3.15, "90th_percentile": 31.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.08, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.09, "10th_percentile": 0.79, "90th_percentile": 8.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 1.8, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.56, "10th_percentile": 3.15, "90th_percentile": 14.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1.8, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.56, "10th_percentile": 3.15, "90th_percentile": 14.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 10.63, "10th_percentile": 3.5, "90th_percentile": 16.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.94, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 3.83, "10th_percentile": 0.79, "90th_percentile": 7.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 12.33, "10th_percentile": 4.06, "90th_percentile": 18.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1.8, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.37, "10th_percentile": 1.58, "90th_percentile": 14.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 8.19, "10th_percentile": 1.75, "90th_percentile": 16.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.08, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.42, "10th_percentile": 0.91, "90th_percentile": 8.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 14.88, "10th_percentile": 4.9, "90th_percentile": 22.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3.11, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.09, "10th_percentile": 0.79, "90th_percentile": 8.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 5.18, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.56, "10th_percentile": 3.15, "90th_percentile": 14.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 5.18, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.56, "10th_percentile": 3.15, "90th_percentile": 14.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 5.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 10.63, "10th_percentile": 3.5, "90th_percentile": 16.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 2.69, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 3.83, "10th_percentile": 0.79, "90th_percentile": 7.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 6.67, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 12.33, "10th_percentile": 4.06, "90th_percentile": 18.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 5.18, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.37, "10th_percentile": 1.58, "90th_percentile": 14.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 5.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 8.19, "10th_percentile": 1.75, "90th_percentile": 16.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3.11, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.42, "10th_percentile": 0.91, "90th_percentile": 8.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 8.05, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 14.88, "10th_percentile": 4.9, "90th_percentile": 22.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 5.74, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.09, "10th_percentile": 0.79, "90th_percentile": 8.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 9.56, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.56, "10th_percentile": 3.15, "90th_percentile": 14.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 9.56, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.56, "10th_percentile": 3.15, "90th_percentile": 14.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 10.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 10.63, "10th_percentile": 3.5, "90th_percentile": 16.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 4.97, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 3.83, "10th_percentile": 0.79, "90th_percentile": 7.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 12.33, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 12.33, "10th_percentile": 4.06, "90th_percentile": 18.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 9.56, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.37, "10th_percentile": 1.58, "90th_percentile": 14.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 10.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 8.19, "10th_percentile": 1.75, "90th_percentile": 16.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 5.74, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.42, "10th_percentile": 0.91, "90th_percentile": 8.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 14.88, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 14.88, "10th_percentile": 4.9, "90th_percentile": 22.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 8.24, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.09, "10th_percentile": 0.79, "90th_percentile": 8.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 13.73, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.56, "10th_percentile": 3.15, "90th_percentile": 14.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 13.73, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.56, "10th_percentile": 3.15, "90th_percentile": 14.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 15.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 10.63, "10th_percentile": 3.5, "90th_percentile": 16.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 7.14, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 3.83, "10th_percentile": 0.79, "90th_percentile": 7.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 17.69, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 12.33, "10th_percentile": 4.06, "90th_percentile": 18.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 13.73, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.37, "10th_percentile": 1.58, "90th_percentile": 14.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 15.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 8.19, "10th_percentile": 1.75, "90th_percentile": 16.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 8.24, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.42, "10th_percentile": 0.91, "90th_percentile": 8.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 21.35, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 14.88, "10th_percentile": 4.9, "90th_percentile": 22.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 9.11, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.09, "10th_percentile": 0.79, "90th_percentile": 8.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 15.19, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.56, "10th_percentile": 3.15, "90th_percentile": 14.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 15.19, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.56, "10th_percentile": 3.15, "90th_percentile": 14.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 16.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 10.63, "10th_percentile": 3.5, "90th_percentile": 16.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 7.9, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 3.83, "10th_percentile": 0.79, "90th_percentile": 7.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 19.58, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 12.33, "10th_percentile": 4.06, "90th_percentile": 18.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 15.19, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.37, "10th_percentile": 1.58, "90th_percentile": 14.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 16.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 8.19, "10th_percentile": 1.75, "90th_percentile": 16.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 9.11, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.42, "10th_percentile": 0.91, "90th_percentile": 8.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 23.63, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 14.88, "10th_percentile": 4.9, "90th_percentile": 22.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.74, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.09, "10th_percentile": 0.79, "90th_percentile": 8.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.81, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.09, "10th_percentile": 0.79, "90th_percentile": 8.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.88, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.09, "10th_percentile": 0.79, "90th_percentile": 8.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.64, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 3.83, "10th_percentile": 0.79, "90th_percentile": 7.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 1.35, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.37, "10th_percentile": 1.58, "90th_percentile": 14.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 1.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 8.19, "10th_percentile": 1.75, "90th_percentile": 16.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.74, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.42, "10th_percentile": 0.91, "90th_percentile": 8.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3.0, "10th_percentile": 3.0, "90th_percentile": 3.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 1.2, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% 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 Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 1.2, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% 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 Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 0.96, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.96, "10th_percentile": 0.96, "90th_percentile": 0.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 1.06, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 1.06, "10th_percentile": 1.06, "90th_percentile": 1.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 0.9, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 0.9, "10th_percentile": 0.9, "90th_percentile": 0.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.58, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 0.7, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.7, "10th_percentile": 0.7, "90th_percentile": 0.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 2.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 1.74, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.74, "10th_percentile": 1.74, "90th_percentile": 1.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1.95, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 1.95, "10th_percentile": 1.95, "90th_percentile": 1.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 2.55, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% 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 procedures; 85% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 2.46, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 2.46, "10th_percentile": 2.46, "90th_percentile": 2.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 1.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1.5, "10th_percentile": 1.5, "90th_percentile": 1.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 2.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 3.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 3.0, "10th_percentile": 3.0, "90th_percentile": 3.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 1.94, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 1.75, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.75, "10th_percentile": 1.75, "90th_percentile": 1.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3.0, "10th_percentile": 3.0, "90th_percentile": 3.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 3.0, "10th_percentile": 3.0, "90th_percentile": 3.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 3.0, "10th_percentile": 3.0, "90th_percentile": 3.0, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.0, "10th_percentile": 3.0, "90th_percentile": 3.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ALBUTEROL SULFATE 2.5 MG/0.5 ML INH NEBU", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-97580", "type": "CDM" }, { "code": "25000000", "type": "LOCAL" }, { "code": "0250", "type": "RC" }, { "code": "76204-0027-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.64, "maximum": 30.0, "setting": "outpatient", "gross_charge": 30.0, "discounted_cash": 21.0, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC 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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC 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": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC 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": "NMHC 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": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC 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": "HEALTHLINK [125]", "plan_name": "NMHC 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": "NMHC 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": "NMHC 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": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 30.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 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 (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 8.1, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.42, "10th_percentile": 1.48, "90th_percentile": 7.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 13.5, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.5, "10th_percentile": 13.5, "90th_percentile": 13.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 13.5, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.5, "10th_percentile": 13.5, "90th_percentile": 13.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 15.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 15.0, "10th_percentile": 15.0, "90th_percentile": 15.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 7.02, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 3.83, "10th_percentile": 1.28, "90th_percentile": 6.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 17.4, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% 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 OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 13.5, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.5, "10th_percentile": 13.5, "90th_percentile": 13.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 15.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 15.0, "10th_percentile": 15.0, "90th_percentile": 15.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 8.1, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.42, "10th_percentile": 1.48, "90th_percentile": 7.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 21.0, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 21.0, "10th_percentile": 21.0, "90th_percentile": 21.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.74, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.42, "10th_percentile": 1.48, "90th_percentile": 7.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.64, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 3.83, "10th_percentile": 1.28, "90th_percentile": 6.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.74, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.42, "10th_percentile": 1.48, "90th_percentile": 7.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "ALBUTEROL SULFATE 90 MCG/ACTUATION INH HFAA", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-17837", "type": "CDM" }, { "code": "CHRG1841", "type": "LOCAL" }, { "code": "0637", "type": "RC" } ], "standard_charges": [ { "minimum": 61.6, "maximum": 317.5, "setting": "outpatient", "gross_charge": 317.5, "discounted_cash": 222.25, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 85.73, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 85.73, "10th_percentile": 85.73, "90th_percentile": 85.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 317.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 317.5, "10th_percentile": 317.5, "90th_percentile": 317.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 317.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 317.5, "10th_percentile": 317.5, "90th_percentile": 317.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 317.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 317.5, "10th_percentile": 317.5, "90th_percentile": 317.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 317.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 317.5, "10th_percentile": 317.5, "90th_percentile": 317.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 142.88, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 142.88, "10th_percentile": 142.88, "90th_percentile": 142.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 158.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 158.75, "10th_percentile": 158.75, "90th_percentile": 158.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 317.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 317.5, "10th_percentile": 317.5, "90th_percentile": 317.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 317.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 317.5, "10th_percentile": 317.5, "90th_percentile": 317.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 317.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 317.5, "10th_percentile": 317.5, "90th_percentile": 317.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 101.6, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 101.6, "10th_percentile": 101.6, "90th_percentile": 101.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 112.08, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 112.08, "10th_percentile": 112.08, "90th_percentile": 112.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 95.25, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 95.25, "10th_percentile": 95.25, "90th_percentile": 95.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 61.6, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 61.6, "10th_percentile": 61.6, "90th_percentile": 61.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 73.98, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 73.98, "10th_percentile": 73.98, "90th_percentile": 73.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 254.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 254.0, "10th_percentile": 254.0, "90th_percentile": 254.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 184.47, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 184.47, "10th_percentile": 184.47, "90th_percentile": 184.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 206.38, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 206.38, "10th_percentile": 206.38, "90th_percentile": 206.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 269.88, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 269.88, "10th_percentile": 269.88, "90th_percentile": 269.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 260.35, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 260.35, "10th_percentile": 260.35, "90th_percentile": 260.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 158.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 158.75, "10th_percentile": 158.75, "90th_percentile": 158.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 127.0, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 127.0, "10th_percentile": 127.0, "90th_percentile": 127.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 127.0, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 127.0, "10th_percentile": 127.0, "90th_percentile": 127.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 317.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 317.5, "10th_percentile": 317.5, "90th_percentile": 317.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 254.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 254.0, "10th_percentile": 254.0, "90th_percentile": 254.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 317.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $317.50 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 317.5, "10th_percentile": 317.5, "90th_percentile": 317.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $317.50 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 205.74, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 205.74, "10th_percentile": 205.74, "90th_percentile": 205.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 185.1, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 185.1, "10th_percentile": 185.1, "90th_percentile": 185.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 317.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 317.5, "10th_percentile": 317.5, "90th_percentile": 317.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 317.5, "10th_percentile": 317.5, "90th_percentile": 317.5, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 317.5, "10th_percentile": 317.5, "90th_percentile": 317.5, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 317.5, "10th_percentile": 317.5, "90th_percentile": 317.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ALBUTEROL SULFATE 90 MCG/ACTUATION INH HFAA", "drug_information": { "unit": 8.5, "type": "GR" }, "code_information": [ { "code": "RX-17837", "type": "CDM" }, { "code": "CHRG1841", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "45802-0088-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 27.98, "maximum": 582.5, "setting": "outpatient", "gross_charge": 582.5, "discounted_cash": 407.75, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 157.28, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.07, "10th_percentile": 40.45, "90th_percentile": 126.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 262.13, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 176.24, "10th_percentile": 107.52, "90th_percentile": 244.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 582.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 200.75, "10th_percentile": 170.35, "90th_percentile": 506.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 262.13, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 176.24, "10th_percentile": 107.52, "90th_percentile": 244.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 291.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 195.81, "10th_percentile": 119.47, "90th_percentile": 272.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 136.31, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 91.64, "10th_percentile": 55.91, "90th_percentile": 127.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 582.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 391.63, "10th_percentile": 238.93, "90th_percentile": 544.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 337.85, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 227.15, "10th_percentile": 138.58, "90th_percentile": 315.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 262.13, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 90.34, "10th_percentile": 70.0, "90th_percentile": 227.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 291.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 100.38, "10th_percentile": 77.78, "90th_percentile": 253.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 157.28, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 105.74, "10th_percentile": 64.51, "90th_percentile": 146.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 407.75, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 274.14, "10th_percentile": 167.25, "90th_percentile": 381.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 54.2, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.07, "10th_percentile": 40.45, "90th_percentile": 126.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 90.34, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 176.24, "10th_percentile": 107.52, "90th_percentile": 244.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 200.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 200.75, "10th_percentile": 170.35, "90th_percentile": 506.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 90.34, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 176.24, "10th_percentile": 107.52, "90th_percentile": 244.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 100.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 195.81, "10th_percentile": 119.47, "90th_percentile": 272.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 46.98, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 91.64, "10th_percentile": 55.91, "90th_percentile": 127.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 200.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 391.63, "10th_percentile": 238.93, "90th_percentile": 544.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 116.44, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 227.15, "10th_percentile": 138.58, "90th_percentile": 315.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 90.34, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 90.34, "10th_percentile": 70.0, "90th_percentile": 227.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 100.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 100.38, "10th_percentile": 77.78, "90th_percentile": 253.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 54.2, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 105.74, "10th_percentile": 64.51, "90th_percentile": 146.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 140.53, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 274.14, "10th_percentile": 167.25, "90th_percentile": 381.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 43.94, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.07, "10th_percentile": 40.45, "90th_percentile": 126.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 38.95, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.07, "10th_percentile": 40.45, "90th_percentile": 126.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 162.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 200.75, "10th_percentile": 170.35, "90th_percentile": 506.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 64.91, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 90.34, "10th_percentile": 70.0, "90th_percentile": 227.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 72.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 100.38, "10th_percentile": 77.78, "90th_percentile": 253.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 144.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 162.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 200.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 582.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 144.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 162.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 200.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 582.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 144.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 162.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 200.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 582.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 144.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 162.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 200.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 582.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 582.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 200.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 162.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 144.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 582.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 200.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 162.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 144.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 144.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 162.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 200.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 582.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 181.75, "10th_percentile": 149.8, "90th_percentile": 467.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 144.25, "10th_percentile": 144.25, "90th_percentile": 144.25, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 144.25, "10th_percentile": 144.25, "90th_percentile": 144.25, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 144.25, "10th_percentile": 144.25, "90th_percentile": 144.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 46.16, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 46.16, "10th_percentile": 46.16, "90th_percentile": 46.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 50.92, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 50.92, "10th_percentile": 50.92, "90th_percentile": 50.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 43.28, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 43.28, "10th_percentile": 43.28, "90th_percentile": 43.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 27.98, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 27.98, "10th_percentile": 27.98, "90th_percentile": 27.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 33.61, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 33.61, "10th_percentile": 33.61, "90th_percentile": 33.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 115.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 115.4, "10th_percentile": 115.4, "90th_percentile": 115.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 83.81, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 83.81, "10th_percentile": 83.81, "90th_percentile": 83.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 93.76, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 93.76, "10th_percentile": 93.76, "90th_percentile": 93.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 122.61, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 122.61, "10th_percentile": 122.61, "90th_percentile": 122.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 118.29, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 118.29, "10th_percentile": 118.29, "90th_percentile": 118.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 72.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 72.13, "10th_percentile": 72.13, "90th_percentile": 72.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 57.7, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 57.7, "10th_percentile": 57.7, "90th_percentile": 57.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 57.7, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 57.7, "10th_percentile": 57.7, "90th_percentile": 57.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 144.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 144.25, "10th_percentile": 144.25, "90th_percentile": 144.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 115.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 115.4, "10th_percentile": 115.4, "90th_percentile": 115.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 144.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $144.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 144.25, "10th_percentile": 144.25, "90th_percentile": 144.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $144.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 93.47, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 93.47, "10th_percentile": 93.47, "90th_percentile": 93.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 84.1, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 84.1, "10th_percentile": 84.1, "90th_percentile": 84.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 144.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 144.25, "10th_percentile": 144.25, "90th_percentile": 144.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" } ] } ] }, { "description": "ALBUTEROL SULFATE 90 MCG/ACTUATION INH HFAA", "drug_information": { "unit": 6.7, "type": "GR" }, "code_information": [ { "code": "RX-17837", "type": "CDM" }, { "code": "CHRG1841", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "69097-0142-60", "type": "NDC" } ], "standard_charges": [ { "minimum": 27.98, "maximum": 582.75, "setting": "outpatient", "gross_charge": 582.75, "discounted_cash": 407.92, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 582.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 271.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 162.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 144.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 582.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 271.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 162.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 144.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 582.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 271.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 162.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 144.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 144.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 162.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 271.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 582.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 144.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 162.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 271.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 582.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 582.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 271.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 162.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 144.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 144.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 162.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 271.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 582.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 216.88, "10th_percentile": 149.8, "90th_percentile": 489.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 38.95, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 58.55, "10th_percentile": 40.45, "90th_percentile": 132.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 43.94, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 58.55, "10th_percentile": 40.45, "90th_percentile": 132.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 162.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 271.0, "10th_percentile": 184.4, "90th_percentile": 520.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 64.91, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 121.95, "10th_percentile": 76.32, "90th_percentile": 234.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 72.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 135.5, "10th_percentile": 84.8, "90th_percentile": 260.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 73.17, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 58.55, "10th_percentile": 40.45, "90th_percentile": 132.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 121.95, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 192.09, "10th_percentile": 135.98, "90th_percentile": 248.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 271.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 271.0, "10th_percentile": 184.4, "90th_percentile": 520.4, "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": "NMHC SCPP IPA", "standard_charge_dollar": 121.95, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 192.09, "10th_percentile": 135.98, "90th_percentile": 248.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 135.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 213.44, "10th_percentile": 151.09, "90th_percentile": 275.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 63.41, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 99.89, "10th_percentile": 70.7, "90th_percentile": 129.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 271.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 426.88, "10th_percentile": 302.18, "90th_percentile": 551.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 157.18, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 247.59, "10th_percentile": 175.26, "90th_percentile": 319.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 121.95, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 121.95, "10th_percentile": 76.32, "90th_percentile": 234.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 135.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 135.5, "10th_percentile": 84.8, "90th_percentile": 260.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 73.17, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 115.25, "10th_percentile": 81.59, "90th_percentile": 148.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 189.7, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 298.81, "10th_percentile": 211.52, "90th_percentile": 386.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 157.34, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 58.55, "10th_percentile": 40.45, "90th_percentile": 132.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 262.24, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 192.09, "10th_percentile": 135.98, "90th_percentile": 248.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 582.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 271.0, "10th_percentile": 184.4, "90th_percentile": 520.4, "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": "NMHC SCPP IPA", "standard_charge_dollar": 262.24, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 192.09, "10th_percentile": 135.98, "90th_percentile": 248.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 291.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 213.44, "10th_percentile": 151.09, "90th_percentile": 275.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 136.36, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 99.89, "10th_percentile": 70.7, "90th_percentile": 129.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 582.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 426.88, "10th_percentile": 302.18, "90th_percentile": 551.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 338.0, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 247.59, "10th_percentile": 175.26, "90th_percentile": 319.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 262.24, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 121.95, "10th_percentile": 76.32, "90th_percentile": 234.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 291.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 135.5, "10th_percentile": 84.8, "90th_percentile": 260.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 157.34, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 115.25, "10th_percentile": 81.59, "90th_percentile": 148.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 407.93, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 298.81, "10th_percentile": 211.52, "90th_percentile": 386.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 144.25, "10th_percentile": 144.25, "90th_percentile": 144.25, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "standard_charge_algorithm": "No contract line matched", "median_amount": 144.25, "10th_percentile": 144.25, "90th_percentile": 144.25, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 144.25, "10th_percentile": 144.25, "90th_percentile": 144.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 46.16, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 46.16, "10th_percentile": 46.16, "90th_percentile": 46.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 50.92, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 50.92, "10th_percentile": 50.92, "90th_percentile": 50.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 43.28, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 43.28, "10th_percentile": 43.28, "90th_percentile": 43.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 27.98, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% Billed", "median_amount": 27.98, "10th_percentile": 27.98, "90th_percentile": 27.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 19.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 33.61, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 33.61, "10th_percentile": 33.61, "90th_percentile": 33.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 115.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 80% Billed", "median_amount": 115.4, "10th_percentile": 115.4, "90th_percentile": 115.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Remaining Charges; 80% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 83.81, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 83.81, "10th_percentile": 83.81, "90th_percentile": 83.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 93.76, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 93.76, "10th_percentile": 93.76, "90th_percentile": 93.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 122.61, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 122.61, "10th_percentile": 122.61, "90th_percentile": 122.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 118.29, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 118.29, "10th_percentile": 118.29, "90th_percentile": 118.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 72.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 72.13, "10th_percentile": 72.13, "90th_percentile": 72.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_dollar": 57.7, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 57.7, "10th_percentile": 57.7, "90th_percentile": 57.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 57.7, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 57.7, "10th_percentile": 57.7, "90th_percentile": 57.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_dollar": 144.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 144.25, "10th_percentile": 144.25, "90th_percentile": 144.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 115.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 80% Billed", "median_amount": 115.4, "10th_percentile": 115.4, "90th_percentile": 115.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 80% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 144.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $144.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 144.25, "10th_percentile": 144.25, "90th_percentile": 144.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $144.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 93.47, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 93.47, "10th_percentile": 93.47, "90th_percentile": 93.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 84.1, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 84.1, "10th_percentile": 84.1, "90th_percentile": 84.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 144.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 144.25, "10th_percentile": 144.25, "90th_percentile": 144.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" } ] } ] }, { "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": 1.5, "maximum": 73.0, "setting": "outpatient", "gross_charge": 73.0, "discounted_cash": 51.1, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 73.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 40.38, "10th_percentile": 14.28, "90th_percentile": 66.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 40.38, "10th_percentile": 14.28, "90th_percentile": 66.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 73.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 73.0, "10th_percentile": 73.0, "90th_percentile": 73.0, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 73.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 73.0, "10th_percentile": 73.0, "90th_percentile": 73.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 73.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 40.38, "10th_percentile": 14.28, "90th_percentile": 66.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 40.38, "10th_percentile": 14.28, "90th_percentile": 66.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 40.38, "10th_percentile": 14.28, "90th_percentile": 66.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 73.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 40.38, "10th_percentile": 14.28, "90th_percentile": 66.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 73.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 40.38, "10th_percentile": 14.28, "90th_percentile": 66.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 40.38, "10th_percentile": 14.28, "90th_percentile": 66.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 40.38, "10th_percentile": 14.28, "90th_percentile": 66.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 73.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 40.38, "10th_percentile": 14.28, "90th_percentile": 66.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 73.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 40.38, "10th_percentile": 14.28, "90th_percentile": 66.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 40.38, "10th_percentile": 14.28, "90th_percentile": 66.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 73.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 40.38, "10th_percentile": 14.28, "90th_percentile": 66.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 40.38, "10th_percentile": 14.28, "90th_percentile": 66.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 32.85, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 32.85, "10th_percentile": 32.85, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 32.85, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 32.85, "10th_percentile": 32.85, "90th_percentile": 32.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3.49, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.17, "10th_percentile": 6.43, "90th_percentile": 29.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 32.85, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.17, "10th_percentile": 6.43, "90th_percentile": 29.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 19.71, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.9, "10th_percentile": 3.85, "90th_percentile": 17.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2.09, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.9, "10th_percentile": 3.85, "90th_percentile": 17.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 19.71, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 19.71, "10th_percentile": 19.71, "90th_percentile": 19.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 36.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 36.5, "10th_percentile": 36.5, "90th_percentile": 36.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 20.19, "10th_percentile": 7.14, "90th_percentile": 33.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 36.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 20.19, "10th_percentile": 7.14, "90th_percentile": 33.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 17.08, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 10.73, "10th_percentile": 5.66, "90th_percentile": 15.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 4.39, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 10.73, "10th_percentile": 5.66, "90th_percentile": 15.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 42.34, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 26.61, "10th_percentile": 14.03, "90th_percentile": 39.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 10.88, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 26.61, "10th_percentile": 14.03, "90th_percentile": 39.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 51.1, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 32.12, "10th_percentile": 16.93, "90th_percentile": 47.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 13.13, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 32.12, "10th_percentile": 16.93, "90th_percentile": 47.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH 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": "NMH ADVOCATE IPA", "standard_charge_dollar": 3.1, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 3.1, "10th_percentile": 3.1, "90th_percentile": 3.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_dollar": 3.1, "standard_charge_percentage": 40.0, "standard_charge_algorithm": "All Services; 40% Billed", "median_amount": 3.1, "10th_percentile": 3.1, "90th_percentile": 3.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 40% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA", "standard_charge_dollar": 2.48, "standard_charge_percentage": 32.0, "standard_charge_algorithm": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of 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": "All Outpatient; 32% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $7.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 7.75, "10th_percentile": 7.75, "90th_percentile": 7.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Not priced - Needs Review; 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $7.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 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 - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC CORE", "standard_charge_dollar": 4.52, "standard_charge_percentage": 58.3, "standard_charge_algorithm": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "Table 5 Services; 58.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC", "standard_charge_dollar": 5.02, "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.02, "10th_percentile": 5.02, "90th_percentile": 5.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 64.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 5.04, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 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": "All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_dollar": 3.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3.88, "10th_percentile": 3.88, "90th_percentile": 3.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_dollar": 6.36, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Procedures; 82% Billed", "median_amount": 6.36, "10th_percentile": 6.36, "90th_percentile": 6.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 82% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BROAD", "standard_charge_dollar": 4.5, "standard_charge_percentage": 58.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.5, "10th_percentile": 4.5, "90th_percentile": 4.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 58.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA BEHAVIORAL HEALTH (EVERNORTH)", "standard_charge_dollar": 6.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "Remaining Charges; 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": "Remaining Charges; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_dollar": 6.59, "standard_charge_percentage": 85.0, "standard_charge_algorithm": "all procedures; 85% Billed", "median_amount": 6.59, "10th_percentile": 6.59, "90th_percentile": 6.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "all procedures; 85% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA ALTERNATIVE", "standard_charge_dollar": 1.81, "standard_charge_percentage": 23.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.81, "10th_percentile": 1.81, "90th_percentile": 1.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 23.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.5, "standard_charge_percentage": 19.4, "standard_charge_algorithm": "All Services; 19.4% 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 Services; 19.4% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_dollar": 2.33, "standard_charge_percentage": 30.0, "standard_charge_algorithm": "All Other OP Services; 30% Billed", "median_amount": 2.33, "10th_percentile": 2.33, "90th_percentile": 2.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP Services; 30% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA ASA", "standard_charge_dollar": 2.74, "standard_charge_percentage": 35.3, "standard_charge_algorithm": "All Outpatient; 35.3% Billed", "median_amount": 2.74, "10th_percentile": 2.74, "90th_percentile": 2.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient; 35.3% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH PHCS PPO", "standard_charge_dollar": 6.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other OP; 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 OP; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA TRANSPLANT", "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NMH CIGNA LIFESOURCE TRANSPLANT", "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH IL HEALTH PARTNERS IPA", "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": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "gross_charge": 88345.0, "discounted_cash": 61841.5, "payers_information": [ { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "NMH Optum UBH", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 88338.75, "10th_percentile": 88338.75, "90th_percentile": 88338.75, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.861505175; Using historical claim(s); Scope: All Financial Classes; Cases: 8; All IP Services; 100% Billed", "median_amount": 88338.75, "10th_percentile": 88338.75, "90th_percentile": 88338.75, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.861505175; Using historical claim(s); Scope: All Financial Classes; Cases: 8; All IP Services - OON; 100% Billed", "median_amount": 88338.75, "10th_percentile": 88338.75, "90th_percentile": 88338.75, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services (Non-Contracted); 100% Billed", "median_amount": 50541.26, "10th_percentile": 42718.05, "90th_percentile": 77013.15, "count": "27", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.768147455; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services (Non-Contracted); 100% Billed", "median_amount": 50541.26, "10th_percentile": 42718.05, "90th_percentile": 77013.15, "count": "27", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.850818495; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services (Non-Contracted); 100% Billed", "median_amount": 50541.26, "10th_percentile": 42718.05, "90th_percentile": 77013.15, "count": "27", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.861505175; Using historical claim(s); Scope: All Financial Classes; Cases: 8; All IP Services (Non-Contracted); 100% Billed", "median_amount": 50541.26, "10th_percentile": 42718.05, "90th_percentile": 77013.15, "count": "27", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.850818495; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 50495.75, "10th_percentile": 41606.95, "90th_percentile": 50568.56, "count": "19", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.768147455; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 100% Billed", "median_amount": 50495.75, "10th_percentile": 41606.95, "90th_percentile": 50568.56, "count": "19", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 50495.75, "10th_percentile": 41606.95, "90th_percentile": 50568.56, "count": "19", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 50541.26, "10th_percentile": 42718.05, "90th_percentile": 77013.15, "count": "27", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.768147455; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 100% Billed", "median_amount": 50541.26, "10th_percentile": 42718.05, "90th_percentile": 77013.15, "count": "27", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.850818495; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 50541.26, "10th_percentile": 42718.05, "90th_percentile": 77013.15, "count": "27", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.861505175; Using historical claim(s); Scope: All Financial Classes; Cases: 8; All IP Services; 100% Billed", "median_amount": 50541.26, "10th_percentile": 42718.05, "90th_percentile": 77013.15, "count": "27", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 50541.26, "10th_percentile": 42718.05, "90th_percentile": 77013.15, "count": "27", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.768147455; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 100% Billed", "median_amount": 50541.26, "10th_percentile": 42718.05, "90th_percentile": 77013.15, "count": "27", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.850818495; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 50541.26, "10th_percentile": 42718.05, "90th_percentile": 77013.15, "count": "27", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.861505175; Using historical claim(s); Scope: All Financial Classes; Cases: 8; All IP Services; 100% Billed", "median_amount": 50541.26, "10th_percentile": 42718.05, "90th_percentile": 77013.15, "count": "27", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.861505175; Using historical claim(s); Scope: All Financial Classes; Cases: 8; All IP Services; 100% Billed", "median_amount": 50541.26, "10th_percentile": 42718.05, "90th_percentile": 77013.15, "count": "27", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.850818495; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 50541.26, "10th_percentile": 42718.05, "90th_percentile": 77013.15, "count": "27", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.768147455; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 100% Billed", "median_amount": 50541.26, "10th_percentile": 42718.05, "90th_percentile": 77013.15, "count": "27", "methodology": "percent of total billed charges" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 50541.26, "10th_percentile": 42718.05, "90th_percentile": 77013.15, "count": "27", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 50541.26, "10th_percentile": 42718.05, "90th_percentile": 77013.15, "count": "27", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.768147455; Using historical claim(s); Scope: All Financial Classes; Cases: 10; All IP Services; 100% Billed", "median_amount": 50541.26, "10th_percentile": 42718.05, "90th_percentile": 77013.15, "count": "27", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.850818495; 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Using historical claim(s); Scope: All Financial Classes; Cases: 8; All IP Services; 100% Billed", "median_amount": 50541.26, "10th_percentile": 42718.05, "90th_percentile": 77013.15, "count": "27", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 44985.76, "10th_percentile": 40504.95, "90th_percentile": 49466.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.850818495; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 44985.76, "10th_percentile": 40504.95, "90th_percentile": 49466.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.850818495; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 39% Billed", "median_amount": 17478.53, "10th_percentile": 15783.75, "90th_percentile": 19278.78, "count": "12", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.837759174; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services; 39% Billed", "median_amount": 17478.53, "10th_percentile": 15783.75, "90th_percentile": 19278.78, "count": "12", "methodology": "percent of total billed charges" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_percentage": 39.0, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 39% Billed", "median_amount": 17478.53, "10th_percentile": 15783.75, "90th_percentile": 19278.78, "count": "12", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 25293.4, "10th_percentile": 20812.58, "90th_percentile": 40394.18, "count": "17", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 25293.4, "10th_percentile": 20812.58, "90th_percentile": 40394.18, "count": "17", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 25293.4, "10th_percentile": 20812.58, "90th_percentile": 40394.18, "count": "17", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 22764.05, "10th_percentile": 18731.32, "90th_percentile": 36354.76, "count": "17", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 22764.05, "10th_percentile": 18731.32, "90th_percentile": 36354.76, "count": "17", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 22764.05, "10th_percentile": 18731.32, "90th_percentile": 36354.76, "count": "17", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA BP", "standard_charge_percentage": 30.0, "standard_charge_algorithm": "Re-evaluated: HLB.861505175; Using historical claim(s); Scope: All Financial Classes; Cases: 8; All IP Services; 30% Billed", "median_amount": 26501.63, "10th_percentile": 26501.63, "90th_percentile": 26501.63, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All Inpatient Services; 70% Billed", "median_amount": 31490.03, "10th_percentile": 28353.47, "90th_percentile": 34626.59, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_percentage": 70.0, "standard_charge_algorithm": "Re-evaluated: HLB.850818495; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All Inpatient Services; 70% Billed", "median_amount": 31490.03, "10th_percentile": 28353.47, "90th_percentile": 34626.59, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services (Non-Contracted); 55% Billed", "median_amount": 24742.17, "10th_percentile": 22277.72, "90th_percentile": 27206.61, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Re-evaluated: HLB.850818495; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services (Non-Contracted); 55% Billed", "median_amount": 24742.17, "10th_percentile": 22277.72, "90th_percentile": 27206.61, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 20243.6, "10th_percentile": 18227.23, "90th_percentile": 22259.96, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 20243.6, "10th_percentile": 18227.23, "90th_percentile": 22259.96, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 22492.89, "10th_percentile": 20252.48, "90th_percentile": 24733.3, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMH SEIU HEALTHLINK", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Re-evaluated: HLB.861505175; Using historical claim(s); Scope: All Financial Classes; Cases: 8; Inpatient Services; 50% Billed", "median_amount": 44169.38, "10th_percentile": 44169.38, "90th_percentile": 44169.38, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMH AETNA NM EMPLOYEES", "standard_charge_percentage": 19.4, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 17137.7, "10th_percentile": 17137.7, "90th_percentile": 17137.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN PLATINUM/CHC ELITE", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 57420.19, "10th_percentile": 57420.19, "90th_percentile": 57420.19, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/20 EPO", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 72437.78, "10th_percentile": 72437.78, "90th_percentile": 72437.78, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NMH HFN/10 PPO", "standard_charge_percentage": 85.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 75087.94, "10th_percentile": 75087.94, "90th_percentile": 75087.94, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH ADVOCATE IPA", "standard_charge_percentage": 40.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 35335.5, "10th_percentile": 35335.5, "90th_percentile": 35335.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMH CHS IPA", "standard_charge_percentage": 40.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 35335.5, "10th_percentile": 35335.5, "90th_percentile": 35335.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 22492.89, "10th_percentile": 20252.48, "90th_percentile": 24733.3, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 20243.6, "10th_percentile": 18227.23, "90th_percentile": 22259.96, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 20243.6, "10th_percentile": 18227.23, "90th_percentile": 22259.96, "count": "1 through 10", "methodology": "percent of total billed charges" } ] } ] }, { "description": "ALLOGRAFT PROT NERVE AXOGUARD 3.5X40MM", "code_information": [ { "code": "SUP-336731", "type": "CDM" }, { "code": "C1763", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1387.91, "maximum": 18926.28, "setting": "outpatient", "gross_charge": 9647.76, "discounted_cash": 6753.43, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9647.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 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100% Billed", "median_amount": 13214.02, "10th_percentile": 10361.01, "90th_percentile": 17783.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 18926.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13214.02, "10th_percentile": 10361.01, "90th_percentile": 17783.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9647.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13214.02, "10th_percentile": 10361.01, "90th_percentile": 17783.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13214.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13214.02, "10th_percentile": 10361.01, "90th_percentile": 17783.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 18926.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13214.02, "10th_percentile": 10361.01, "90th_percentile": 17783.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9647.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13214.02, "10th_percentile": 10361.01, "90th_percentile": 17783.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13214.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13214.02, "10th_percentile": 10361.01, "90th_percentile": 17783.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 18926.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13214.02, "10th_percentile": 10361.01, "90th_percentile": 17783.83, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 9647.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13214.02, "10th_percentile": 10361.01, "90th_percentile": 17783.83, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13214.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13214.02, "10th_percentile": 10361.01, "90th_percentile": 17783.83, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 18926.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13214.02, "10th_percentile": 10361.01, "90th_percentile": 17783.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 13214.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 16070.15, "10th_percentile": 13785.25, "90th_percentile": 18355.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 18926.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 16070.15, "10th_percentile": 13785.25, "90th_percentile": 18355.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 18926.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 13214.02, "10th_percentile": 10361.01, "90th_percentile": 17783.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 13214.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 13214.02, "10th_percentile": 10361.01, "90th_percentile": 17783.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 9647.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 13214.02, "10th_percentile": 10361.01, "90th_percentile": 17783.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC SEIU HEALTHLINK", "standard_charge_dollar": 3819.75, "standard_charge_percentage": 55.0, "standard_charge_algorithm": "All Services; 55% Billed", "median_amount": 3819.75, "10th_percentile": 3819.75, "90th_percentile": 3819.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 55% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 7664.13, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 9320.68, "10th_percentile": 7995.44, "90th_percentile": 10645.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 10977.24, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 9320.68, "10th_percentile": 7995.44, "90th_percentile": 10645.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 9249.81, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 11249.1, "10th_percentile": 9649.67, "90th_percentile": 12848.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 13248.4, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 11249.1, "10th_percentile": 9649.67, "90th_percentile": 12848.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1387.91, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 2358.61, "10th_percentile": 1459.08, "90th_percentile": 4027.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1625.13, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 2358.61, "10th_percentile": 1459.08, "90th_percentile": 4027.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 3092.08, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 2358.61, "10th_percentile": 1459.08, "90th_percentile": 4027.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 4428.75, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 2358.61, "10th_percentile": 1459.08, "90th_percentile": 4027.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 9463.14, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 8035.07, "10th_percentile": 6892.62, "90th_percentile": 9177.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 6607.01, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 8035.07, "10th_percentile": 6892.62, "90th_percentile": 9177.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 9463.14, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 8035.07, "10th_percentile": 6892.62, "90th_percentile": 9177.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 6607.01, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 8035.07, "10th_percentile": 6892.62, "90th_percentile": 9177.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1601.44, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3567.79, "10th_percentile": 1994.71, "90th_percentile": 4801.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3567.79, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3567.79, "10th_percentile": 1994.71, "90th_percentile": 4801.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 5110.1, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3567.79, "10th_percentile": 1994.71, "90th_percentile": 4801.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1601.44, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3086.35, "10th_percentile": 1902.48, "90th_percentile": 4647.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2604.9, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3086.35, "10th_percentile": 1902.48, "90th_percentile": 4647.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 3567.79, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3086.35, "10th_percentile": 1902.48, "90th_percentile": 4647.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 5110.1, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3086.35, "10th_percentile": 1902.48, "90th_percentile": 4647.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 8516.83, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7231.57, "10th_percentile": 6203.36, "90th_percentile": 8259.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 5946.31, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7231.57, "10th_percentile": 6203.36, "90th_percentile": 8259.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 5946.31, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7231.57, "10th_percentile": 6203.36, "90th_percentile": 8259.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 8516.83, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7231.57, "10th_percentile": 6203.36, "90th_percentile": 8259.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 5946.31, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7231.57, "10th_percentile": 6203.36, "90th_percentile": 8259.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 8516.83, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7231.57, "10th_percentile": 6203.36, "90th_percentile": 8259.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "ALLOGRAFT TRIAD CC LORDOTIC 6X11X14MM", "code_information": [ { "code": "SUP-336922", "type": "CDM" }, { "code": "C1734", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 720.14, "maximum": 6638.9, "setting": "outpatient", "gross_charge": 2667.2, "discounted_cash": 1867.04, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2667.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5611.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6638.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2667.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5611.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6638.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2667.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5611.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6638.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2667.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5611.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6638.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2667.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5611.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6638.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2667.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5611.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6638.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2667.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5611.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6638.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 5611.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6125.4, "10th_percentile": 5714.6, "90th_percentile": 6536.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 6638.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6125.4, "10th_percentile": 5714.6, "90th_percentile": 6536.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 6638.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 5611.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2667.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 5611.9, "10th_percentile": 3256.14, "90th_percentile": 6433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC SEIU HEALTHLINK", "standard_charge_dollar": 3651.4, "standard_charge_percentage": 55.0, "standard_charge_algorithm": "All Services; 55% Billed", "median_amount": 3651.4, "10th_percentile": 3651.4, "90th_percentile": 3651.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 55% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 3254.9, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 3552.73, "10th_percentile": 3314.47, "90th_percentile": 3790.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 3850.56, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 3552.73, "10th_percentile": 3314.47, "90th_percentile": 3790.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 3928.33, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 4287.78, "10th_percentile": 4000.22, "90th_percentile": 4575.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 4647.23, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 4287.78, "10th_percentile": 4000.22, "90th_percentile": 4575.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1313.18, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1553.5, "10th_percentile": 1361.24, "90th_percentile": 1553.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1553.5, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1553.5, "10th_percentile": 1361.24, "90th_percentile": 1553.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1553.5, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1553.5, "10th_percentile": 1361.24, "90th_percentile": 1553.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2805.95, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3062.7, "10th_percentile": 2857.3, "90th_percentile": 3268.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3319.45, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3062.7, "10th_percentile": 2857.3, "90th_percentile": 3268.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2805.95, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3062.7, "10th_percentile": 2857.3, "90th_percentile": 3268.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3319.45, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3062.7, "10th_percentile": 2857.3, "90th_percentile": 3268.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "IMAGINE HEALTH [6032]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1515.21, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1653.86, "10th_percentile": 1542.94, "90th_percentile": 1764.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1792.5, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1653.86, "10th_percentile": 1542.94, "90th_percentile": 1764.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1792.5, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1515.21, "10th_percentile": 879.15, "90th_percentile": 1737.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1515.21, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1515.21, "10th_percentile": 879.15, "90th_percentile": 1737.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 720.14, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1515.21, "10th_percentile": 879.15, "90th_percentile": 1737.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 2987.51, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2756.44, "10th_percentile": 2571.58, "90th_percentile": 2941.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 2525.36, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2756.44, "10th_percentile": 2571.58, "90th_percentile": 2941.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2525.36, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2756.44, "10th_percentile": 2571.58, "90th_percentile": 2941.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2987.51, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2756.44, "10th_percentile": 2571.58, "90th_percentile": 2941.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2525.36, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2756.44, "10th_percentile": 2571.58, "90th_percentile": 2941.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2987.51, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2756.44, "10th_percentile": 2571.58, "90th_percentile": 2941.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "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": 0.54, "maximum": 8.5, "setting": "outpatient", "gross_charge": 7.25, "discounted_cash": 5.07, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.5, "10th_percentile": 5.33, "90th_percentile": 8.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 7.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 8.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 4.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC UHC REF LAB JOHN DEERE", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 3.26, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 2.4, "90th_percentile": 3.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3.26, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 2.4, "90th_percentile": 3.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3.26, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 2.4, "90th_percentile": 3.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3.75, "10th_percentile": 2.66, "90th_percentile": 4.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3.75, "10th_percentile": 2.66, "90th_percentile": 4.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 0.54, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.96, "10th_percentile": 0.81, "90th_percentile": 2.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.96, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.96, "10th_percentile": 0.81, "90th_percentile": 2.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.96, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.02, "10th_percentile": 1.44, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 0.94, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1.7, "10th_percentile": 0.98, "90th_percentile": 1.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1.7, "10th_percentile": 0.98, "90th_percentile": 1.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 4.21, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 4.21, "10th_percentile": 2.44, "90th_percentile": 4.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 4.21, "10th_percentile": 2.44, "90th_percentile": 4.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 5.08, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 5.08, "10th_percentile": 2.94, "90th_percentile": 5.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 5.08, "10th_percentile": 2.94, "90th_percentile": 5.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 3.49, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 2.4, "90th_percentile": 3.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3.49, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 2.4, "90th_percentile": 3.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3.49, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 2.4, "90th_percentile": 3.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3.75, "10th_percentile": 2.66, "90th_percentile": 4.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 3.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3.75, "10th_percentile": 2.66, "90th_percentile": 4.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2.09, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.96, "10th_percentile": 0.81, "90th_percentile": 2.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2.09, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.02, "10th_percentile": 1.44, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1.81, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1.7, "10th_percentile": 0.98, "90th_percentile": 1.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 4.5, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 4.21, "10th_percentile": 2.44, "90th_percentile": 4.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 5.43, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 5.08, "10th_percentile": 2.94, "90th_percentile": 5.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 3.83, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 2.4, "90th_percentile": 3.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3.83, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 2.4, "90th_percentile": 3.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 3.83, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 2.4, "90th_percentile": 3.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 4.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3.75, "10th_percentile": 2.66, "90th_percentile": 4.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 4.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3.75, "10th_percentile": 2.66, "90th_percentile": 4.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2.3, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.96, "10th_percentile": 0.81, "90th_percentile": 2.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 2.3, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.02, "10th_percentile": 1.44, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1.99, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1.7, "10th_percentile": 0.98, "90th_percentile": 1.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 4.93, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 4.21, "10th_percentile": 2.44, "90th_percentile": 4.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 5.95, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 5.08, "10th_percentile": 2.94, "90th_percentile": 5.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "CURAECHOICE [6100]", "plan_name": "NMHC CURAECHOICE", "standard_charge_dollar": 1.05, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All OP Services; 23.4% Billed", "median_amount": 1.7, "10th_percentile": 0.98, "90th_percentile": 1.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 23.4% Billed" }, { "payer_name": "GLOBAL MEDICAL MANAGEMENT INC [6090]", "plan_name": "NMHC GMMI", "standard_charge_dollar": 2.61, "standard_charge_percentage": 58.0, "standard_charge_algorithm": "All OP Services (Non-Contracted); 58% Billed", "median_amount": 4.21, "10th_percentile": 2.44, "90th_percentile": 4.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services (Non-Contracted); 58% Billed" }, { "payer_name": "MEDPARTNERS [6038]", "plan_name": "NMHC MEDPARTNERS", "standard_charge_dollar": 3.15, "standard_charge_percentage": 70.0, "standard_charge_algorithm": "All Outpatient Services; 70% Billed", "median_amount": 5.08, "10th_percentile": 2.94, "90th_percentile": 5.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 70% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3.75, "10th_percentile": 2.66, "90th_percentile": 4.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC UIC IPA", "standard_charge_dollar": 2.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "All Outpatient Services; 50% Billed", "median_amount": 3.75, "10th_percentile": 2.66, "90th_percentile": 4.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.22, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.96, "10th_percentile": 0.81, "90th_percentile": 2.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NMHC IMAGINE HEALTH", "standard_charge_dollar": 1.22, "standard_charge_percentage": 27.0, "standard_charge_algorithm": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.02, "10th_percentile": 1.44, "90th_percentile": 2.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 27% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC CHWN IPA", "standard_charge_dollar": 2.03, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 2.4, "90th_percentile": 3.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2.03, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 2.4, "90th_percentile": 3.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NMHC SCPP IPA", "standard_charge_dollar": 2.03, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 2.4, "90th_percentile": 3.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 45% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.5, "10th_percentile": 5.33, "90th_percentile": 8.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.5, "10th_percentile": 5.33, "90th_percentile": 8.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 7.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "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": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.5, "10th_percentile": 5.33, "90th_percentile": 8.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "GALAXY HEALTH NETWORK [220]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7.25, "10th_percentile": 3.0, "90th_percentile": 8.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NMHC NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.5, "sta